Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of re-rupture following management with a non-operative functional protocol.

We report the outcome of 945 consecutive patients (949 tendons) diagnosed with a rupture of the tendo Achillis managed between 1996 and 2008. There were 255 female and 690 male patients with a mean age of 48.97 years (12 to 86). Delayed presentation was defined as establishing the diagnosis and commencing treatment more than two weeks after injury. The overall rate of re-rupture was 2.8% (27 re-ruptures), with a rate of 2.9% (25 re-ruptures) for those with an acute presentation and 2.7% (two re-ruptures) for those with delayed presentation.

This study of non-operative functional management of rupture of the tendo Achillis is the largest of its kind in the literature. Our rates of re-rupture are similar to, or better than, those published for operative treatment. We recommend our regime for patients of all ages and sporting demands, but it is essential that they adhere to the protocol.

This is the largest detailed study of conservative management of Achilles tendon rupture in the literature to date.

We assessed 140 subjects who had a complete rupture of their Achilles tendon treated with our combined conservative and orthotic regime between 1992 and 1998. Subjects were assessed subjectively and objectively, including isokinetic measurements of ankle plantarflexion and dorsiflexion.

Overall 56% had excellent, 30% good, 12% fair and 2% poor results. The complication rate was 4%, with only 3 tendon reruptures.

When compared with published results for operative repair, our combined conservative and orthotic treatment produces better results overall. Patients are subjectively happier, they have better strength results and have fewer complications.