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Achilles Tendon Laceration Treatment

The Achilles tendon is the flexor tendon located on the backside of the ankle that connects the heel bone to the calf muscle. Injuries to this tendon are common, especially among those who take part in sports. A laceration of the tendon, however, is less common and requires one of two immediate treatments for proper healing.

  1. Conservative Treatment

    • The conservative approach to treating a lacerated Achilles tendon is a non-surgical option that involves the immobilization of the leg. After initially treating any wound involved in the tendon laceration, the actual tendon is allowed to heal on its own by placing the leg in a series of below-the-knee-casts, according to Medscape.com.
      Over the course of six to 12 weeks, doctors will change the casts and set the foot in different flexed positions. The final position will be a plant position and the patient will be asked to begin adding slight weight on the injured foot along with crutches. The foot will not have weight on it for six weeks. Some will be required to wear a heel lift after cast removal.

    Surgical Approach

    • Although there is support for the non-surgical method of healing a lacerated or crushed Achilles, the surgical approach remains the first choice for treatment of the condition. After initial wound treatment, direct tendon care by surgery will take place. The surgery involves reconnecting the tendon and removing scar tissue. The tendon may have to be supplemented and may be longer because of the surgery, but the lengthening (which can cause "push off" problems) will likely be less dramatic than the non-surgical method.
      Following the surgery itself, patients will undergo the casting methods used in the conservative treatment. The patient will have to keep weight off the foot for six weeks or more.

    Suitable for Surgery

    • Sometimes the decision to go with a conservative or surgical version of the treatment depends on the patient. The injured person must be considered suitable for surgery. The presence of skin problems in the area of surgery, poor circulation, advanced age, a sedentary lifestyle or other existing medical problems may make a person less suitable for the surgical method, according to Arthroscopy.com. Athletes and young, otherwise healthy patients are considered the best candidates for surgery.

    Arguments for Both

    • Surgery is the typically preferred method primarily because of its lower rate of re-rupture. According to Orthopaedia.com, the operative treatment has a re-rupture rate of only around two percent, whereas data shows a re-rupture rate of anywhere from 10 to 30 percent for the conservative method of treatment. This is why athletes or those expected to put strain on the tendon in the future are recommended to go with surgery. Infection, stiffness and skin complications are the arguments against surgery.
      The non-surgical conservative method can cause decreased strength in the tendon, because the scar tissue that helps to reconnect the laceration will make the tendon longer, giving it less flexing power. Assuming any surface wound has been properly treated, the conservative method does not carry any risk of infection or skin complication.

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