Is an operation needed to repair a torn Achilles tendon? Doctors still don't agree on the best way to treat these injuries. The Achilles is the tendon that attaches to the calf muscle in the lower leg. Everyone agrees it heals faster with tension, so patients are allowed to use the muscle early on in the recovery process.

But whether or not the tendon heals faster and better with or without surgery is unknown. This study from Switzerland compared two groups of patients with Achilles tendon rupture. The first group was operated on using a simple stitch to repair the torn tendon. Patients wore a cast below the knee. When swelling and pain decreased, the cast was replaced with a special removable splint that allowed walking. The patients were allowed to put weight on the ankle and foot as soon as was possible.

The second group did not have surgery. They were put in an ankle cast and special boot with a heel to keep the ankle in a slightly flexed (foot pointed down) position. This is called the equinus or plantar flexed position. It protects the tendon from overstretching too early. Walking was allowed with as much weight as the patient could handle. The boot (but not the cast) could be taken off at night.

Both groups had good results. People who didn't have surgery went back to work sooner than the surgery group. People who didn't have surgery also had faster pain relief and could walk sooner. However, there were more re-ruptures in the nonoperative group. Some of these injuries were from new accidents, such as falling down stairs.

The authors of this study say nonoperative treatment has to be started right away to be successful. The torn ends of the tendon must be positioned just right for healing in the first 24 to 48 hours. The healing tendon must be protected during the early phase of healing to prevent new ruptures. The most vulnerable phase is from six to 12 weeks after the injury.

**Martin Weber, MD, et al. Nonoperative Treatment of Acute Rupture of the Achilles Tendon. In The American Journal of Sports Medicine. September/October 2003. Vol. 31. No. 5. Pp. 685-691.