Chronic rupture of tendo Achillis.

The Achilles tendon is the most commonly ruptured tendon in the human body. About 20% of complete ruptures of the Achilles tendon are diagnosed late. The management of chronic ruptures of tendo Achillis is usually different from that of acute rupture, as the tendon ends normally will have retracted. As clinical diagnosis of chronic ruptures can be problematic, imaging can be useful. Most investigators counsel operative management, and the possibility of undertaking a tendon transfer should be kept in mind. Local tendons, such as the flexor digitorum longus, the flexor hallucis longus, and the tendon of peroneus brevis, can be used, and some investigators have reported the use of a free gracilis tendon graft. Allografts and synthetic grafts are also employed. There are no comparative studies and no randomized controlled trials to guide clinicians toward an evidence-based approach to management.