How an Achilles Tendon Rupture Is Treated Without Surgery

An Achilles tendon rupture is a traumatic injury that can cause significant disability after it occurs. This condition typically happens without warning and can make it challenging to walk or bear weight through your leg.

While many people end up having their tendon surgically repaired after a tear, this is not always necessary. In fact, a significant number of people may actually be able to rehabilitate their ankle without undergoing a procedure.

This article will discuss Achilles tendon rupture, when surgery may be needed, the effectiveness of nonoperative treatment, and what to expect from nonoperative treatment.

Calf muscle injury on running outdoors. Senior man holding knee by hands and suffering with pain. Sprain ligament or periosteum problem.

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What Is an Achilles Tendon Rupture?

Your Achilles tendon is a thick, fibrous band of tissue that connects two calf muscles (the soleus and the gastrocnemius) to the heel of your foot. This important structure is both the thickest and strongest tendon in the human body.

Huge amounts of force are transmitted through the Achilles on a daily basis. It makes activities like going up on your tiptoes, walking, running, and jumping possible. Additionally, because each of the calf muscles plays an influential role in keeping your balance, an intact Achilles is critical to maintaining stability while you’re on your feet.

Occasionally, the Achilles tendon can either partially or completely rupture (also known as an Achilles tear). This injury typically occurs during a sudden or dramatic movement that strains the calf muscles (like a sprint, jump, or cut). It is frequently accompanied by a popping sensation in the lower portion of the calf.

While a partial tear in this area may have mild or even no symptoms, a complete rupture can cause significant disability because of the Achilles’ many critical functions.

A ruptured Achilles can impact anyone. That said, several groups are more likely to experience this condition than others.

For example, men tear their Achilles at a higher rate than women. In particular, males in their 30s, 40s, and 50s are at a higher risk. In addition, “weekend warriors” who participate in higher-demand sports, like basketball or tennis, that involve a lot of running, cutting, or jumping have a higher rate of injury.

Do I Need Surgery?

Because a ruptured Achilles has a significant impact on your function, treatment is imperative to get you back to your normal tasks.

While a surgical repair of the torn tendon is frequently performed, research suggests this may not always be necessary. In fact, because of how this tendon heals after a rupture, many people can successfully recover from this injury without a procedure.

Your Achilles tendon is situated within a tunnel or sheath that helps it glide back and forth as your calf muscle contracts and relaxes. Following a rupture, a large amount of bleeding occurs within this sheath.

With the correct treatment by your physician and physical therapist, the ends of the residual tendon usually scar down and heal together. This tendinous healing can ultimately allow you to regain function and strength in your ankle.

How Effective Is Nonoperative Treatment?

Nonoperative treatment is an effective (and in some cases better) option for some people after an Achilles tear.

Research has shown that individuals who are treated nonoperatively after a rupture have similar range of motion in their ankles as people who undergo a procedure. In addition, they are able to return to their prior functional levels and athletic activities as well as their surgical counterparts.

While it is true that people who have a surgical repair have less chance of re-rupturing their tendon than people who treat their injury nonoperatively, the overall likelihood of this occurring to either group is low.

Also important to note is the fact that treating a tear with a procedure results in a higher risk of other complications, mainly due to the possibility of post-surgical infection. Because there are pros and cons to both treatment approaches, it is best to speak to your orthopedic surgeon about which option is right for your situation.

What Nonoperative Treatment Entails

Once you have decided to treat your tear nonoperatively, your physician can help you find a physical therapist who will guide you through the doctor’s rehabilitation protocol. While the specifics can vary from surgeon to surgeon, several hallmark rehab components are typically present.

Casting is usually the first step in treating an Achilles tear without surgery. Your foot is pointed in a downward position in the cast to increase the likelihood that the gap in the tendon heals correctly.

After several weeks, the cast is removed and a walking boot is worn in its place. Generally, a heel lift is placed in the boot to reduce the strain on the healing tendon.

Putting weight through the affected leg is usually allowed in this stage, though your doctor may require you to increase the amount of pressure incrementally. Gentle mobility exercises may also be initiated by your therapist during this time.

After several weeks, your doctor will permit you to transition into a shoe. When this occurs, initial calf strengthening and balance exercises are usually also initiated. It is important to progress these carefully and with the guidance of a therapist to ensure the integrity of the healing Achilles.

Calf stretching may also be introduced (usually 12 weeks or more after the initial injury), though it is important not to over-stretch this area. Once you have sufficient strength in your calf muscles, your doctor may clear you to begin higher-level tasks like running or jumping. In total, your entire rehabilitation can take up to six months or longer.

Summary

An Achilles tendon rupture can significantly affect your ability to walk or run. Surgical repair may be done, but there are also nonoperative options. A cast and then a walking boot may be used. After a few weeks, you may graduate to a shoe and begin exercises with a physical therapist.

A Word From Verywell

The moment your Achilles tendon ruptures, you begin a journey toward regaining the function that this injury can take away. While this process can be frustrating at times, it is important to know that you have several treatment options.

If you have experienced a tear, be sure to speak to your physician about whether nonoperative care is appropriate for you. In many cases, you can get back to the activities you love without needing to undergo surgery.

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4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Deng S, Sun Z, ZhangC, Chen G, Li J. Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. The Journal of Foot and Ankle Surgery. 2017;56(6):1236-1243. doi:10.1053/j.jfas.2017.05.036

  4. Ochen Y, Beks RB, HeijlM van, et al. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ. 2019;364:k5120. doi:10.1136/bmj.k5120