Saw a fairly active middle aged patient this weekend in the office…
Fairly straight forward case, went to push off, felt a pop around the ankle. Looked back to see who shot them (typical story).
Diagnosis… Achilles Tendon rupture.
We discussed the alternatives available…. plenty of research supports both non-operative as well as operative management of these injuries. We used a few decision making aids. But It boils down to : Surgical group has higher risk of infection (which can be a nightmare in this area) and the non-surgical group has a higher risk of late re-ruptures. It doesn’t get more exciting…that’s it. Both groups share certain risks… blood clots, etc.
20 minutes after discussion began…. the questions was put to me. “Do I need surgery?” I don’t know, do you? “Doc, I need you to make the decision for me.” Let’s go over the facts again. So we did… and in the end the patient opted for non-operative management. Is this an informed choice success? I think so. I’m sure there are those who will disagree…. but the patient had the facts (evidence based), they took into account their lifestyle and values… and came to what I thought was an appropriate choice.
The patient spent the rest of the weekend talking to their friends who ALL had surgery for their achilles ruptures (most were not offered non-operative mgmt)… so now the patient is re-thinking their decision.
Oh well…. to be continued