We welcome back Foot & Ankle Specialist and Residency Director of Loyola University Medical Center, Dr. Adam Schiff, MD to discuss surgical versus nonsurgical management of Achilles tendon ruptures.  We review the study “Operative versus nonoperative treatment of acute Achilles tendon rupture: a propensity score-matched analysis of a large national dataset“ published in OJSM in February coming to us from Duke University.  In the study, Dr. Brian Lau and his team found an increased risk of complications with surgical versus nonsurgical care, no difference in reoperation rates, and increased costs with surgical care initially but an equalization of costs at 5 years post-injury.  The authors also report that over the study period from 2007-2015, there was little change in the rate of surgical repair, despite the widely published success of modern nonsurgical care.  Dr. Schiff lends his expertise on this topic, lays out the pros and cons of each approach, the historical perspective, what situations might be best suited for each treatment pathway, and the psychology he sees in his patients as they decide whether to have surgical repair of their Achilles tendon rupture.