I haven’t written an article on an injury for a while and as I felt my Achilles tighten this morning, I decided to look at this in more detail. Luckily, mine was only a minor pull, but frequently when you hear of a ruptured Achilles you also hear about surgery being the only option. However, this doesn’t seem to be the case. In fact, surgery may not be the best option at all.
A study available here, by Dr Martin Webber, looked at two groups of patients with Achilles ruptures:
- Group 1 was treated with a boot which held their foot in place and their heel elevated.
- Group 2 had an operation to reattach the Achilles.
The headline findings were:
“Subsidence of pain, return to unaided walking, and return to work was faster in the nonoperatively treated group.”
“Patient satisfaction, return to sports, and ultimate strength was the same for both groups.”
This study was published in a very high profile medical journal in 2003, so why do we still hear about surgical operations being the only option for ruptured Achilles? Perhaps sports teams tend to hire specialists in surgery who always opt for the operation – there are slightly fewer re-ruptures when surgery is used, but this is balanced by other factors. Perhaps the risk of a re-rupture is considered too problematic for professional sports teams and this filters down to other doctors, or perhaps because there is a fairly good success rate in Achilles operations doctors are inclined to continue with “if it ain’t broke, don’t fix it” approach.
There are potential complications associated with each approach so if you have an Achilles issue I suggest you read the study in full and consider these risks. Re-rupture is slightly hire in the group treated with the boot, but then again, 1 subject died in the operation group. You could also note that the study was a retrospective study rather than a full clinical trial and there may be some slight differences between the two groups which could alter conclusions. In all, it’s always worth reading a study in full and deciding if the conclusion is right for you.