The Achilles(TA) is the strongest and thickest tendon in the body as well as the most commonly injured tendon. There is a 25% incidence of missed ruptures on initial evaluation, so a high index of suspicion is necessary on the part of the physician. Patients are usually misled by the inconsequential nature of the trauma, lack of significant pain, and patient’s ability to weakly plantar flex the ankle.Those patients who sustain undiagnosed Achilles ruptures may go on to be considered chronic or neglected ruptures.
Symptoms are vague and not necessarily localized to the Achilles tendon region.
In non-operative treatment, improvement may take years and can be accompanied by a period of pain until healing is complete.It can be considered for those patients who have associated comorbidities, such as peripheral vascular disease.Non-operative treatment is also indicated for those patients who do nothave any significant functional deficits.
Main complication is wound healing due to the long big incision and also because it is difficult to achieve tension free skin closure after reconstruction. Associated risk factors such as steroid and tobacco use, female sex, older age, diabetic and obesity give rise to higher incidence of wound complications.
This technique is recommended chronic TA ruptures, particularly in patients with co-morbidities, as it is less invasive and could potentially reduce the risk of postoperative wound infection which is the most important drawback of the open technique.