Ruptures of the Achilles Tendon

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A rupture of the Achilles tendon is not an uncommon injury in sport and can be quite dramatic when it happens, as the calf muscles and the attached Achilles tendon play such an important function. It is more likely to happen in explosive activities like tennis. The real problem is that the achilles tendon and the two muscles attached to it cross two joints (the knee and the ankle) and if both the joints are moving in opposite directions at the same time, especially if suddenly (as might happen in tennis), then the risk of something going wrong is pretty high. The management of an achilles tendon rupture is a bit controversial as there are two options that almost all the research shows have very similar outcomes. One option is conservative and the other is surgical. The conservative option is usually putting the leg in cast that holds the foot pointing downwards slightly. It can take up to six weeks to heel up and after the cast is removed, there needs to be a slow and gentle return to physical activity. Physical therapy is often used to assist with this. The surgical option is to surgically sew the two ends of the tendon back together, this is followed by a period in a cast that is shorter than the conservative option, and is followed by a similar slow and steady return to activity. When longer term outcomes are compared the final result is usually about the same, but the surgical approach has the added risk of surgical or anaesthetic complications that the conservative approach does not have. The decision as to which approach is better is going to have to be one based on the experiences of the surgeon and the preferences of the person with the rupture. There is a tendency for competitive athletes to go down the surgical pathway as it is believed that this does give a better short term outcome and get them back to the sports field quicker.

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