Achilles tendon ruptures most commonly occur in people who remain active in their 30s and 40s. The body begins to lose its rapid regenerative capacity seen in our youth, and yet many people remain athletically active and put a high strain on the body's ligaments and muscles. The combination of these factors leads tendon ruptures such as the quad tendon, hamstrings tendon, or achilles tendon.
The achilles tendon rupture is treated with or without surgery. 10 years ago all of these were repaired surgically, however, clinical studies have shown that a very compliant patient can heal well with a nonsurgical protocol that involves a cast, and then cam boot with increasing amounts of weight bearing and activity. Both techniques have shown to be good treatment options, although each also has a drawback. The nonsurgical treatment has a slightly higher risk for re-rupture, while the surgical treatment has a higher risk for complications such as wound infection. There is probably no best overall treatment, rather a best treatment for each individual and this needs to be determined via a conversation between the orthopedic surgeon and the patient.
There are many complications that can occur during the treatment of a ruptured achilles tendon. But what can be expected with the best case scenario, will everything be perfect? While its possible that the tendon can heal incredibly well and an aggressive rehab program will return everything to normal, more commonly, most patients will notice small differences between the injured leg and the uninjured leg.
About 20% of people will never be able to return to their previous level of activity.
In professional athletes only about 68% are able to return to their sport, and those that do return experience a 50% decline in play.
One recent study found that the calf muscle (which is the muscle portion of the achilles tendon) remains slightly weaker even 7 years after injury. In fact, after 2 years, the muscle reaches its maximal point of improvement. These deficits are seen in achilles tendon ruptures treated with surgery and without surgery.
Zellers JA, Carmont MR, Gravare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play [published online June 3, 2016]. Br J Sports Med.