One hundred patients were randomly assigned to surgery with early mobilisation or to early mobilisation alone with the removable orthosis and without prior surgery. In every other respect, all the patients in the study had the same treatment. The thesis shows that there is no difference in the re-rupture rate. A year after the injury, there was no difference in the patients’ own impression of symptoms and function, but irrespective of which treatment the patient received, the function tests showed that there remained a substantial difference between the healthy and the injured foot.
This controversy has existed for years. My own experience is that the vast majority of patients treated non-operatively do just as well as those treated operatively. I always present the options to the patient and allow them to decide, and the vast majority over the last few years have chosen non-operative management. The *promise* that surgery restores strength has not been borne out by the literature. The only major difference between open and non-op managed ruptures is the infection rate, and an infection around the Achilles tendon can be a nightmare.