The Missed Achilles Tear: Now what?

Chronic Achilles tendon ruptures are debilitating injuries and are often associated with large tendon gaps that can be challenging for the foot and ankle surgeon to treat. Preoperative evaluation should include the patient's functional goals, medical comorbidities, MRI assessment of gastrocsoleus muscle viability, condition of adjacent flexor tendons, and size of the tendon defect. Although several surgical techniques have been described, the surgeon must formulate an individualized treatment plan for the patient. This article reviews the principles of diagnosis, treatment options, and clinical outcomes, and outlines the authors' preferred techniques.