Achilles Tendon Rupture and Repair
Overview
An Achilles tendon rupture is a complete or partial tear of the tendon at the back of the ankle. Both functional non-surgical rehabilitation and surgical repair can be appropriate for an acute rupture. The choice depends on the injury, timing, tendon position, health, activity goals and ability to follow rehabilitation. Neither option produces an instant recovery, and both require staged protection and strengthening over many months.
Typical symptoms
- A sudden snap or pop at the back of the ankle.
- Immediate weakness and difficulty pushing off, climbing stairs or standing on tiptoe.
- Swelling and bruising around the calf or heel.
- A gap in the tendon, although swelling can make this difficult to feel.
- Pain may settle quickly and does not exclude a complete rupture.
Diagnosis
Diagnosis is usually made from the history and examination, including a calf-squeeze test and assessment of tendon continuity and strength. Ultrasound may be used when the diagnosis, tendon position or treatment plan is uncertain. MRI is not routinely required for a straightforward acute rupture but may help with an unusual, delayed or complex injury.
A suspected rupture should be assessed promptly. Initial management usually protects the ankle in a plantarflexed position rather than stretching the tendon.
Non-surgical functional rehabilitation
Non-surgical treatment uses a cast or Moonboot with heel wedges followed by staged functional rehabilitation. Protected weight-bearing and controlled movement may begin early according to the treating protocol. This approach avoids wound and surgical complications but still requires close follow-up.
Re-rupture, excessive tendon lengthening and reduced push-off strength remain possible. Good results depend on early diagnosis, appropriate protection and reliable participation in the rehabilitation plan.
Surgical repair
Repair may be considered for selected active people, open injuries, delayed presentations, failed non-surgical treatment or when the tendon position and individual goals make the surgical trade-offs reasonable. The tendon is brought together through an open, mini-open or percutaneous technique. A chronic rupture may require tendon advancement, graft or tendon transfer rather than a simple repair.
Surgery may lower re-rupture risk in some settings, but it introduces wound, infection, scar and nerve risks. Modern functional rehabilitation has reduced the difference between surgical and non-surgical treatment for many acute ruptures. Surgery does not remove the need for prolonged rehabilitation.
Recovery and rehabilitation
Whether treatment is surgical or non-surgical, the tendon must be protected while gradually exposed to load. Heel wedges are reduced in stages, ankle movement is progressed and calf strengthening begins under guidance. Sudden stretching or unsupported push-off too early can disrupt healing.
Walking may take several months to normalise. Calf size and endurance often recover more slowly, and some difference from the uninjured side may persist. Return to running, jumping and competitive sport requires adequate strength, control and sport-specific testing rather than time alone.
Risks and possible longer-term effects
- Re-rupture or excessive tendon lengthening.
- Weakness, reduced endurance or difficulty with a single-leg heel rise.
- Stiffness, swelling, scar sensitivity or adhesions.
- Wound breakdown or infection after surgery.
- Sural nerve irritation or numbness.
- Blood clots and other medical complications.
- Need for further surgery or reconstruction.
When to seek urgent care
- A new snap, sudden loss of push-off or change in tendon contour during recovery.
- Increasing wound redness, drainage, fever or severe pain.
- Marked calf swelling, chest pain or shortness of breath.
- A Moonboot or cast that causes severe pressure, numbness, colour change or uncontrolled swelling.
Frequently asked questions
Does every Achilles rupture need surgery?
No. Modern functional non-surgical treatment is a valid option for many people. Treatment is individualised.
Can I walk in the Moonboot?
Often, protected weight-bearing is introduced early under a defined protocol. Do not change wedges or walk without the boot before being instructed.
When can I drive?
Driving requires safe vehicle control, no impairing medication and compliance with licensing and insurer requirements. It is not safe while the right ankle is immobilised or strength and reaction are inadequate.
Will my calf return to normal?
Strength and endurance usually improve substantially, but some calf atrophy or reduction in peak push-off may remain.
What is a chronic rupture?
A rupture diagnosed late may have retracted ends and scar tissue. It often requires a more complex reconstruction and has a different recovery.
General information
This page provides general information only. It cannot diagnose your condition or replace advice from a clinician who has assessed you. Your treatment and recovery plan may differ from the examples described here. Follow the instructions from your treating team. In an emergency, call 000 or attend the nearest emergency department.