Achilles tendon problems are often misdiagnosed, but many patients still have good outcomes, a new study suggests.

For example, about one-quarter of Achilles tendon ruptures are missed during doctors' initial examinations, according to the authors of the clinical review published in the November issue of The Journal of the American Osteopathic Association.

The Achilles tendon, which connects calf muscles at the back of the lower leg to the heel, is the largest tendon in the body and plays a vital role in walking, running and jumping.

The researchers found that most patients healed better with conservative treatment and said surgery should be limited to acute tears in young or very active patients.

"As an osteopathic physician, we approach treating injuries with the least amount of surgical intervention possible," Dr. Joseph Daniel, clinical associate professor of orthopedic surgery at Jefferson Medical College in Philadelphia, said in a journal news release.

"Injuries of the Achilles are no different, and this study validates that most patients are better off with conservative treatment," he added.

However, surgery in younger, athletic patients is associated with a lower risk of re-rupture and a faster return to activity, Daniel said.

The researchers also said that diagnostic imaging, such as MRI or ultrasound, is not recommended for people with Achilles tendon problems unless a rupture is suspected.

"Mismanaged or neglected injuries will markedly decrease a patient's quality of life," Daniel said. "In all but a select few cases, we can resolve the issue with rest, over-the-counter medication, physical therapy, or a few weeks in a walking boot."