Achilles tendonopathy and tendon rupture: conservative versus surgical management

Injuries to the Achilles tendon are common in primary care. Insertional tendonitis, retrocalcaneal bursitis, and paratenonitis are acute injuries usually treated conservatively with rest, ice, anti-inflammatory measures, and physical rehabilitation. Causative factors such as improper training or biomechanical abnormalities must be corrected to prevent reoccurrence. Achilles tendinosis is a chronic condition that does not always cause clinical symptoms. When symptoms occur, they are thought to be due to microtrauma or progressive failure resulting in inflammation. Again, conservative treatment usually relieves symptoms, but treatment may be prolonged. Surgical treatment may occasionally be recommended. With rupture of the Achilles, there exists some controversy regarding the advantage of conservative versus surgical management. Treatment should be based on individual patient considerations and expectations.