Achilles tendon tears, the bane of many middle-aged "weekend warriors," may heal as effectively with a supportive splint and exercises as with surgery, according to Dr. Alexandra Kirkley, associate professor of surgery at the University of Western Ontario, London, Ontario, Canada.

Although surgery is the method typically used for these common sports injuries, the nonsurgical method may be as effective, with fewer risks.

Rupture of the Achilles tendon is a surprisingly common injury, occurring most often in middle-aged people who are trying to stay fit and participate in recreational activities. Some of the sports where people are at risk include basketball, tennis and squash, as well as any other sports that involve jumping and starts and stops.

In this small trial the researchers compared treatment outcomes in 24 people who had torn their Achilles tendon. Among these people, 12 were treated with a splint, and with rehabilitation exercises that emphasized motion and resistance. The other 12 were treated with conventional Achilles repair surgery.

The basic scientific rationale for the splint with exercises is that, if you have a healing tendon and apply motion and resistance, the tendon heals much more completely. The splint protects the tendon, but it allows for motion and load-bearing exercises.

The investigators assessed the outcomes with a questionnaire and with evaluations that included range of motion, walking, and hopping on one foot. According to these measurements, the two groups were very similar at the end of the study.

It's exciting to see that you can get the same result without having to subject someone to the risk of surgery. It looks like motion and stress are important to recovery. Although surgical repair is the conventional method for treating Achilles tendon tears, some patients may have health risks that make surgery unwise, such as diabetics and smokers. Other patients may be reluctant to undergo surgery.

This study shows that it's safe to treat people for an Achilles tendon rupture without surgery. "For the patient who wants to avoid surgery, or for the patient who has risk factors, there is a nonsurgical option that will give them an excellent result."