Acute Achilles tendon ruptures are an increasingly common injury. Although operative fixation continues to be dominant in the United States, a growing body of literature supports nonoperative management. Although the specifics of functional rehabilitation vary, many studies support this management approach. Continued controversies include the type of castor orthosis used, acceptable gap size, need for ultrasound evaluation, time to initiation of weight bearing, time to initiation of motion, duration of orthosis, length of treatment, and use of heel wedges in shoes once the orthosis is discontinued.

Level I.