DW Writes: Dear Dr. Patel, I am an active 43-year old man who was playing basketball last week when I felt a pop in my right heel. Ever since then I have had a painful limp and a lot of swelling on my foot. I saw a local orthopedic surgeon who diagnosed me with an Achilles tendon rupture. He did not get an MRI but told me that my exam was positive for the rupture and he recommended surgery as the best option. Do I really need the surgery?

Dr. Patel writes: DW, it does sound like you do have an Achilles tendon rupture. Always remember that you have an option of not having any surgery. In this case however, I would highly recommend surgery for you.

The Achilles tendon is a primary flexor of the heel. It is useful for pushing off the ground in activities such as jumping and climbing ladders. There are two ways of treating an acute Achilles tendon rupture. One is casting for two months and the other is surgery.

Casting benefits include no risk of surgery but it does have some setbacks. There is a higher rate of re-rupture if the tendon is treated with casting in the future. Also, you have to be non weight-bearing for a longer period of time. There can also be some residual weakness that can result.

Casting is a good option for those who are not good candidates for surgery — those with poor blood circulation or severe diabetes.

Surgery has a quicker recovery period and also less chance of re-rupture or weakness. There is always some risk with any surgery. The biggest complication that can occur is a wound healing problem. The skin in that area has poor circulation and someone with diabetes is at very high risk of having an infection. Sometimes nerve damage can occur and there is also anesthesia risk with any surgery. In your case however, I would still recommend surgery.

Dr. Manish Patel has extensive training in treating shoulder, elbow and knee injuries, and performing arthroscopic surgery. He is the principal medical practitioner in the offices of Southampton Orthopaedic and Sports Medicine Center, on the campus of Southampton Memorial Hospital. Submit questions about sports medicine, injuries and treatment for this column to sports@tidewaternews.com, or call Dr. Patel at 562-7301.