Achilles tendon rupture: Should I have surgery? - Quest Diagnostics Patient Health Library

1. Get the Facts

Your options

Have surgery for a ruptured Achilles tendon.
Treat the rupture with a cast or brace (immobilization).

Key points to remember

You can treat an Achilles tendon rupture with surgery or by using a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization).
Both surgery and immobilization are usually successful. Another rupture is less likely after surgery than after immobilization. But immobilization has fewer risks.
The success of your surgery depends on many things, including how badly your tendon is damaged, how soon after your rupture you have surgery, and your rehabilitation program after the surgery.
If you are younger or are physically active in sports, at work, or at home, surgery is often advised. If you are older or are inactive, immobilization is often advised.

FAQs

What is the Achilles tendon, and what is an Achilles tendon rupture?

The Achilles tendon connects the calf muscles to the heel bone. It is the biggest tendon in the human body, and it allows you to rise up on your toes while walking. It withstands a large amount of force with each foot movement.

An Achilles tendon rupture occurs when the tendon is completely torn in two. When this happens, your leg may be weak, and walking may be difficult. You may not be able to rise up on your toes. An Achilles tendon rupture must be treated.

How well do treatments work?

Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon and can be done with one large incision (open surgery) or many smaller incisions (percutaneous surgery).

Nonsurgical treatment starts with immobilizing your leg. This prevents you from moving the lower leg and ankle so that the ends of the Achilles tendon can reattach and heal. A cast, splint, brace, walking boot, or other device may be used to do this.

Both immobilization and surgery are often successful. They both help the tendon to heal. Another rupture is less likely after surgery than after immobilization, but immobilization has fewer risks.

Among people who have open surgery, about 2 out of 100 will have another rupture after surgery. If percutaneous surgery is done, about 4 out of 100 may have another rupture.¹
Among people who have immobilization, about 10 out of 100 will have another rupture.¹

The success of your surgery depends on:

Your surgeon's experience.
The type of surgery you have (percutaneous or open surgery).
How badly your tendon is damaged.
How soon after the rupture your surgery is done.
How soon your rehabilitation program starts after surgery.
How well you follow your rehab program.

What are the risks of surgery?

The risks of surgery are similar, whether you have percutaneous surgery or open surgery. The biggest risk of either type of surgery is wound infection. Your risk can also change depending on whether you begin walking and using your foot sooner after surgery rather than later. This is called early mobilization.

Risks of percutaneous surgery

Minor wound infection: About 5 out of 100 people who have this type of surgery will have a minor wound infection or delayed healing.¹

Risks of open surgery

Minor wound infection: About 12 out of 100 people who have open surgery will have a minor wound infection or delayed healing.¹
Major wound infection: About 2 out of 100 people who have open surgery will have a deep wound infection.¹

The risk of minor pain and temporary nerve damage is about the same for both types of surgeries. About 8 out of 100 people will have these problems. There is also a slight risk of deep vein thrombosis or permanent nerve damage with either type of surgery.

What are the risks of immobilization?

With immobilization, the greatest risk is that the tendon will rupture again. Among people who have immobilization, about 10 out of 100 will have another rupture.¹

As with surgery, minor pain and temporary nerve damage are also risks when immobilization with a cast or brace is used. About 8 out of 100 people who have immobilization treatment will have these problems. There is also a very slight risk of deep vein thrombosis or permanent nerve damage with nonsurgical treatment.

Why might your doctor recommend surgery for a ruptured Achilles tendon?

Your doctor may advise surgery if:

You are physically active in sports, at work, or at home.
You have a job that requires leg strength.

2. Compare Options

	Have surgery for Achilles tendon rupture	Treat the rupture with a cast or brace (immobilization)
What is usually involved?	You will most likely go home the same day as surgery. You will spend 6 to 12 weeks after surgery wearing a walking cast or boot. If you sit at work, you can go back in 1 to 2 weeks. If you're on your feet at work, you may need 6 to 8 weeks before you can go back.	You'll wear a cast, splint, brace, walking boot, or other device for several months. Your total recovery time can take up to 6 months.
What are the benefits?	Surgery repairs the tendon and makes another rupture less likely. You can go back to work and resume daily activities sooner than with immobilization.	Immobilization allows you to avoid surgery and the risk of wound infection.
What are the risks and side effects?	You may have: Minor pain and temporary nerve damage. Slight risk of deep vein thrombosis or permanent nerve damage. A small risk of repeat tendon rupture. All surgery has risks, including bleeding and infection. Your age and your health can also increase your risk.	You may have: Repeat tendon rupture. Loss of strength in the leg. Minor pain and temporary nerve damage. A very slight risk of deep vein thrombosis or permanent nerve damage.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Achilles Tendon Problems.

Personal stories about surgery for Achilles tendon rupture

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I blew out my Achilles playing basketball—and we still lost! I've talked to my doctor about this, and he recommends surgery, as I want to continue playing basketball and am active in a lot of other ways. I'm going with an open surgery because that seems to be the best for not having another rupture. I realize there is more of a possibility for wound infection, but that's worth the risk—I don't want to pop my Achilles again, and, to tell the truth, I don't really worry about infections. "

— Carlo, age 34

"I don't really know how I did it, but I ruptured my Achilles tendon. I guess sometimes a simple action can do it. I don't like the idea of surgery, so I'm going with a cast and a good rehab program. Although I like to go for walks, I'm not an athlete by any means, so my doctor says I probably shouldn't have to worry about doing it again. "

— Marian, age 55

"And I thought my injury days were over! I gave up playing sports a while back, but I still referee young children's soccer games. At the last one I did, whack, there went my Achilles. Now I have to decide what to do. I'm not overly active, but I still like to get around. I'm also getting to the point where surgery and potential complications bother me, but on the other hand, I really don't want another rupture. My doctor told me he knows a surgeon who is very experienced in a type of surgery that does not make a big cut—I believe it's called percutaneous surgery. This surgery is supposed to solidly fix the tendon but have less risk of complications. This sounds good to me, especially because the surgeon is experienced. "

— Brandi, age 45

"I started jogging again after quite a few years, and a week later blam!—out goes my Achilles. Talk about bad luck! My doc says surgery would be no problem, as I'm a young guy in good health. But surgery just bugs me. I'd rather have a cast, even if my doc says an operation gives me less risk of doing it again. But I've learned my lesson. After the cast comes off, I'll pay more attention to warming up and stretching. I won't be in the 10% who have rerupture after using a cast! "

— Fred, age 33

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose surgery for a ruptured Achilles tendon

Reasons to choose a cast or brace (immobilization) to treat a ruptured Achilles tendon

I don't want to risk having another tendon rupture.

I'm willing to take the risk of having another tendon rupture if it means not having surgery.

More important

Equally important

More important

My job requires that I have strong legs.

My job doesn't require that I have strong legs.

More important

Equally important

More important

I'm not worried about the risks of surgery.

I'm worried about the risks of surgery.

More important

Equally important

More important

I'm an active person, and I want to stay active.

I am not very active in my daily life, and being active is not that important to me.

More important

Equally important

More important

I want to return to my normal activity levels as soon as possible.

The long recovery time does not bother me.

More important

Equally important

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My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

Immobilization

Leaning toward

Undecided

Leaning toward

5. Quiz Yourself

Check the facts.

1. If I get a cast or brace, I am more likely to have another rupture than if I have surgery.

True
False
I'm not sure

You're right. You are more likely to have another rupture after immobilization treatment than after surgery.

2. Either treatment will help heal my tendon, but immobilization has fewer risks.

True
False
I'm not sure

You are right. Both treatments are usually successful, but immobilization has fewer risks.

3. I am physically active at work and at home, so immobilization may be the best choice for me.

True
False
I'm not sure

You are right. If you are physically active in sports, at work, or at home, surgery is often advised.

Decide what's next.

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a choice?

Yes
No

Certainty.

1. How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2. Check what you need to do before you make this decision.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.