Treatment of Torn Achilles Tendon

Should you have surgery?

Man pinching his Achilles tendon.

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When you tear your Achilles tendon, there are several ways it can be treated. There is not necessarily a best treatment, just a best option for each individual. You need to discuss the pros and cons of each with your doctor to see which is right for you.

Non-Surgical Options

Traditionally, non-surgical treatment was reserved for individuals who live sedentary lifestyles or who may have problems with surgical wound healing. This includes people who smoke, have diabetes, or use steroids. Active people were more likely to be steered to surgical options.

However, according to a paper published in 2017, more recent studies have shown that most patients can consider non-surgical treatment of a torn Achilles tendon, and expect results similar to those who might opt for surgery. Some studies have shown that patients who have non-surgical treatment have a higher chance or re-injury (re-rupture) of the tendon, and perhaps a more difficult time for athletes returning to sports.

Nonsurgical treatment of an Achilles tendon rupture is accomplished by casting or bracing the Achilles tendon for several months. The foot starts in a pointed position, which helps bring the torn ends of the tendon together, and over time the foot is gradually brought upwards. Most often the ankle is immobilized for a total of 8 to 10 weeks, and then motion and strengthening exercises are started.

Surgical Options

Surgery is also an option to treat an Achilles tendon rupture. It has a better success rate at preventing re-rupture and often you will have better push-off strength and ankle function. Performing Achilles tendon repair involves an incision along the back of the ankle. Usually, the incision is made just to the side of midline so shoes will not rub on the site of the scar. The torn ends of the Achilles tendon are identified and strong sutures are placed in both ends of the tendon. These strong sutures are then tied together to repair the tendon.

Surgery Complications

The most common and worrisome complications following an Achilles tendon repair are problems with wound healing. The skin over the Achilles tendon sometimes does not heal well. Therefore, careful wound management is of utmost important following surgical repair of an Achilles tendon rupture. Other potential problems include infection, ankle stiffness, nerve pain and re-rupture of the tendon.


Rehabilitation following Achilles tendon repair is a controversial topic. Traditionally, patients were put into a cast after surgery for a period of 4 to 8 weeks, and after that time were allowed to gently begin moving the ankle.

More recently, some surgeons have advocated for a more rapid progression and return to activity. The goal of accelerated rehabilitation is to prevent the muscle atrophy and joint stiffness that worsens the longer the joint is immobilized. If a solid repair is attainable, patients may not be put into a cast at all and allowed to begin motion soon after surgery. These patients will use a removable boot when walking for several weeks.

It is important to discuss your treatment options with your doctor to understand which is the best choice for your condition.

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  1. Egger AC, Berkowitz MJ. Achilles tendon injuriesCurr Rev Musculoskelet Med. 2017;10(1):72–80. doi:10.1007/s12178-017-9386-7

  2. Johns Hopkins Medicine. Achilles Tendon Repair Surgery.

  3. Gulati V, Jaggard M, Al-Nammari SS, et al. Management of achilles tendon injury: A current concepts systematic reviewWorld J Orthop. 2015;6(4):380–386. Published 2015 May 18. doi:10.5312/wjo.v6.i4.380