High quality evidence has revealed that non-operative management of acute Achilles tendon rupture achieves optimal outcomes in most patients. Among non-operative treatment options, the most commonly used are functional bracing (walking boot with heel wedges) and casting in equinus position. There has been a recent move towards early mobilization and more use of functional bracing over casts in a number of different areas, and it is unclear if there is a benefit in favour of either strategy in the context of Achilles tendon ruptures. In this study, the authors randomized patients to plaster cast versus functional bracing, and performed an accompanying economic evaluation. They found that patients treated with functional brace had significantly better functional scores at eight weeks, and that bracing was dominant from a cost-effectiveness perspective, with modest savings and slightly better utility. There was no difference in terms of rate of adverse events or functional scores beyond 8 weeks.