Achilles tendon repair is performed under general or regional anesthesia and takes 45–60 minutes. The approach depends on the severity and location of the rupture:

​

1. Open Repair (Traditional Approach)

• A small incision (5–10 cm) is made over the Achilles tendon.

• The torn ends are stitched together using strong sutures.

​​

2. Minimally Invasive (Percutaneous) Repair

• Small incisions (1–2 cm) are made.

• Special instruments pass sutures through the tendon with less soft tissue disruption.

• Associated with faster recovery and lower wound complications.

​​

3. Augmented Repair (for Chronic or Large Tears)

• If the tendon is severely damaged, a tendon graft (e.g., from the hamstring or flexor hallucis longus tendon) may be used to reinforce the repair.

​​

The foot is then placed in a cast or boot to protect the repair during initial healing.

Non-surgical treatment may be an option for low-demand patients or those with medical conditions that increase surgical risks. This involves:

​

• Immobilization in a walking boot with the foot pointed down (plantarflexion).

• Functional rehabilitation with gradual weight-bearing.

​​

Studies suggest that non-operative treatment can achieve similar outcomes to surgery if an early rehabilitation protocol is followed. However, surgery is generally recommended for young, active individuals due to the lower risk of re-rupture and faster return to sports.

Achilles tendon surgery is effective but carries some risks:

​

General Surgical Risks:

• Infection (2–4% risk with open surgery) – Due to limited blood supply in the area. Minimally invasive techniques reduce this risk.

• Blood Clots (DVT/PE) – Prolonged immobilization can increase the risk, requiring blood thinners in high-risk patients.

• Nerve Injury – The sural nerve, running along the Achilles tendon, may be injured, leading to numbness or tingling on the side of the foot.

• Wound Healing Issues – More common in smokers, diabetics, or those with poor circulation.

​​

Procedure-Specific Risks:

• Re-Rupture – Lower with surgery (~5%) compared to non-operative treatment (~12–20%).

• Tendon Stiffness or Weakness – Some loss of strength or reduced push-off power may persist.

• Adhesions or Scar Tissue Formation – Can cause stiffness and require extended physiotherapy.

• Calf Muscle Atrophy – Muscle shrinkage may occur due to prolonged immobilization.

​​

Long-term studies show that over 80–90% of patients regain good function, but full strength recovery may take up to 12 months.

Time Off Work

• Desk jobs: 2–4 weeks

• Manual labor: 12+ weeks

 

Return to Driving

• 6–8 weeks, depending on the foot operated and recovery progress.

​​

Return to Activities & Sports

• Walking unaided: 8–10 weeks

• Running: 4–6 months

• Full sports participation: 9–12 months

 

Rehabilitation Timeline

• Weeks 0–2: Immobilization in a cast or boot (non-weight-bearing).

• Weeks 2–6: Gradual weight-bearing in a boot with wedges.

• Weeks 6–12: Physiotherapy for strength, flexibility, and balance.

• 3–6 months: Progressive return to jogging and low-impact sports.

• 6–12 months: High-impact activities and full return to sports.

 

Most athletes return to competitive sports within 9–12 months, with structured rehabilitation improving outcomes.