My 55-year old husband is a sports nut and hurt himself playing basketball. The doctor thinks he has a torn Achilles tendon. How do you know when to do surgery and when to let it heal on its own? The doctor is leaving the decision up to us.

Management of Achilles ruptures has become more complex now that older adults want to remain active in recreational sports. Return to play may require a different approach than just going back to daily activities.

If the two ends of the tendon can be brought back together when the foot is pointed downward slightly, then casting in this position may be all that’s needed. Sometimes ultrasound is used to make sure the gap can be reduced.

Surgery is advised if the surgeon suspects the gap cannot be closed. The rate of re-rupture is higher in patients with more severe tears who treat it nonoperatively. The tendon is also weaker if treated without surgery to repair it.

More surgeons advise active adults in good health with good blood supply to have the surgery. It will increase the chances of returning to previous levels of sports activity. It also reduces the risk of re-rupture. Once healing has occurred, patients are advised to gently stretch the tendon daily to prevent reinjury.