Joanne, Kevin and other interested
Surgical repair is definitley preferable if the rupture is diagnosed and
operated on early before tendon atrophy. There was a very good article on
this area last year which showed a re-rupture rate of 21% if treated
conservatively compared to 2% if treated surgically. Interestingly there
was no functional difference in strength and peformance between the two
groups.
For those interested see:
Moller M, Movin T, Granhed H, et al: Acute rupture of tendo Achilles. A
prospective randomized study of comparison between surgical and
non-surgical treatment. Br J Bone Joint Surg. 2001; 83(6):843-848
Cheers
Ben  At 08:00 PM 9/16/02 -0700, you wrote:
>Joanne:
>
>You wrote:
>
><<I have a 31 year old friend who over the weekend ruptured his Achilles
>tendon whilst playing rugby.
>
>He has been told that there are two possible routes of treatment. The first
>is to cast the foot in a plantarflexed position and hope that the tendon
>reattaches, then to have serial casts every two weeks to bring the foot up
>from the plantarflexed position.
>
>The second is surgical repair but he is told the risks of complications of
>this sort of surgery are very high and therefore it would be better to try
>the casting method and see how it goes.
>
>He asked for my advice on what he should do and I was unable to help. He is
>also concerned because he runs is own business and time off his feet is
>costing him money, he has been advised that he will be unable to work for at
>least 6 months.
>
>I would be very grateful if any one out there who has experience of this
>type of injury management could let me know there views and experiences.>>
>
>If it was **my** Achilles tendon that ruptured, I would be having it
>surgically repaired the next day by one of my surgeon friends.  Here in
>California, primary repair of the Achilles tendon is the standard of care
>for athletic individuals who have a complete rupture of the Achilles tendon.
>Many times these are reinforced with flaps from the gastrocnemius
>aponeurosis or from the plantaris tendon.  The risks of this surgery are not
>"very high".  This surgeons sounds like he is trying to "talk the patient
>out of the surgery", for whatever reason.
>
>As Ralph said, the patient can be back to work within a week with crutches
>or a rolling walker.  He will be nonweightbearing for about six weeks
>following the surgery.  I'll bet if this individual was a professional rugby
>player that he would be having his Achilles tendon rupture surgically
>repaired within a few days from injury.  My advice:  get it repaired!
>
>Cheers,
>
>Kevin
>
>*****************************************************
>Kevin A. Kirby, DPM
>Assistant Clinical Professor of Biomechanics
>California College of Podiatric Medicine
>
>Private practice:
>107 Scripps Drive, Suite #200
>Sacramento, CA  95825
>
>Voice: (916) 925-8111   Fax: (916) 925-8136
>e-mail:  [log in to unmask]
>*****************************************************
>
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Ben Yates MSc, BSc (Hons), FCPod (Surg)
Head of Podiatry & Podiatric Surgeon
La Trobe University
Melbourne, 3086
Victoria
Australia
Tel: + 61 3 9479 5839
Fax: + 61 3 9479 5784

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