ACHILLES TENDON RUPTURE TREATMENT

. Acute
. Nonoperative for acute ruptures
. Cast or brace immobilization (nonweight-bearing, 6–8 weeks)
. Operative for acute ruptures
. Open vs. percutaneous repair (Ma procedure)
. Ma (lower incidence of wound problems)
. Lower rate of rerupture with direct repair
. Chronic
. Nonoperative for chronic ruptures
. AFO or similar bracing (palliative care)
. Operative for chronic ruptures
. Achilles reconstruction using graft (salvage procedure)
. Flexor hallucis longus
. Fascial graft
. Peroneus brevis
. Rehabilitation
. Goals of physical therapy: ROM and strengthening
. 5–6months before return to contact sports
. Role of earlier ROMgaining greater popularity
Prognosis
. Results of conservative or operative repair generally good (greater
strength with repair)
. Results of treatment after chronic rupture not as good as with acute
Repair
. Reconstruction generally does not allow for return to competitive
Sports
. Complications
. Rerupture (greater with conservative treatment)
. Equinus (heel cord tightness)
. Skin slough, infection, painful scar
Caveats and Pearls
. Careful handling of the soft tissue is imperative to avoid wound
complications.