I am a fashion model at a very high level with a serious problem. I fell during one of our shows and ruptured my left Achilles tendon. The doctor I saw wants to do surgery but I can’t afford to have any scars on my legs. How big is the scar and how much will it show? Is there any way around this problem?

The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleus muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb.

Treatment for an acute Achilles tendon rupture can be with conservative (nonoperative) care or surgery to repair the damage. Surgery involves reattaching the two ends of the tendon to repair the torn Achilles tendon. This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. Numerous procedures have been developed to repair the tendon, but most involve sewing the two ends of the tendon together in some fashion. Some repair techniques have been developed to minimize the size of the incision.

In the past, the complications of surgical repair of the Achilles tendon made surgeons think twice before suggesting surgery. The complications arose because the skin where the incision must be made is thin and has a poor blood supply. This can lead to an increase in the chance of the wound not healing and infection setting in. Now that this is better recognized, the complication rate is lower and surgery is recommended more often.

But the risks of adhesions developing and an unsightly scar are still greater with surgery than without. As a model, you are more likely to be wearing shoes with elevated heels, which puts the tendon in a shortened position. A slightly pointed foot with elevated heal is required during the healing process. Surgery may not be needed if conservative care can restore needed motion and strength for this type of work.

What you should keep in mind during the decision-making process is that rerupture of the Achilles tendon is three times more likely in patients who opt for conservative care over surgery. So there are trade-offs and factors to consider with both treatment approaches. Before agreeing to surgery, you may want to get a second opinion and/or consider a trial of conservative care first.

Athletes and active patients may prefer the stronger tendon that comes with surgical repair. Less active and older adults with fewer biomechanical demands on the damaged tendon may opt for the nonoperative approach.