Nonrandomized Achilles

Inclusion Criteria: Patients presenting with a complete mid-substance rupture of the Achilles tendon as diagnosed on clinical exam (with a positive Thompson squeeze test and a palpable gap in the tendon substance) and confirmed by MRI imaging, who are willing and able to comply with and participate in the rehabilitation protocol, have presented in a timely manner to allow initiation of either treatment within 7 days of their injury, and provide informed consent are candidates for study participation.

Exclusion Criteria: Patients who were not placed in a NWB plantar flexed cast within 24 hours of Injury. Patients with an open Achilles injury, an Achilles injury that is not a mid-substance tendon injury (ie. an Achilles avulsion from the calcaneal insertion or a musculotendinous junction tear/rupture), any additional injury to the ipsilateral lower extremity, a prior rupture or other significant injury to the same Achilles tendon, any functional impairment (physical or mental) that may interfere with compliance with the rehabilitation protocol, any, known factor for increased risk of Achilles tendon rupture (i.e. diabetes mellitus, immunosuppressive therapy including local or systemic steroids, and fluoroquinolone use)