I was knocked over by a 100-pound dog chasing a squirrel. I twisted my ankle with enough force to tear the tendon along the outside of my right ankle. The surgeon gave me a choice to try physical therapy or schedule surgery for next week. I'm not really sure what to do. What do you think I should do?

You may need a follow-up phone call or visit with your selected surgeon before making your final decision. It may be helpful to have the therapist evaluate your situation and offer his or her opinion as well. Here are some things to consider. Are there other leg, ankle, or foot soft tissue or bony structures that were damaged at the time of your injury?

Sometimes a tendon rupture pulls a small piece of bone away from the ankle. This type of injury may require a short period of immobilization to allow healing to occur without movements of the foot and ankle disrupting the damaged area. Another consideration is the extent of damage done to the tendon itself. A tear of less than half the tendon fibers can often be managed with conservative (nonoperative) care such as physical therapy.

The injury is given a fair chance to heal and recover. If symptoms have not improved, or the ankle remains unstable after three to six months of conservative care, then surgery may be the next step. If the surgeon gave you a choice between the two treatment options, then it's likely you are a good candidate for nonoperative care.

If more than 50 per cent of the tendon was torn or you are a competitive athlete eager to get back into training and play, then early surgery may be your best option. Anyone involved in activities that stress the ankle may require the stability surgical reconstruction can offer to avoid repeated injuries.