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Surgery for an Achilles Tendon Rupture

Surgery Overview

There are two types of surgery to repair a ruptured Achilles tendon:

  • In open surgery, the surgeon makes a single large incision in the back of the leg.
  • In percutaneous surgery, the surgeon makes several small incisions rather than one large incision.

In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.

What To Expect After Surgery

After either type of surgery, you will likely wear a cast, walking boot, or similar device for 6 to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down). Many health professionals recommend starting movement and weight-bearing exercises early, before the cast or boot comes off. Your total recovery time will probably be as long as 6 months.

Why It Is Done

This surgery is done to repair an Achilles tendon that has been torn into two pieces.

How Well It Works

In general:

  • Both open and percutaneous surgeries are successful. More than 80 out of 100 people who have surgery for an Achilles tendon rupture are able to return to all the activities they did before the injury, including returning to sports.1
  • Although percutaneous surgery has traditionally been viewed as having higher rerupture rates than open surgery, studies now show that the rerupture rates are similar. About 5 out of 100 people who have surgery for an Achilles tendon rupture will rerupture after surgery.2
  • Open surgery is more likely than percutaneous surgery to result in wound healing problems. But damage to a nerve is more likely with percutaneous surgery. Newer techniques for percutaneous surgery may make nerve damage less likely than when older techniques are used.

It is sometimes difficult to know how surgeries compare, because the ages and activities of those having the surgeries differ. The success of your surgery can depend on your surgeon's experience, the type of surgical procedure used, the extent of tendon damage, how soon after rupture the surgery is done, and how soon your rehabilitation program starts after surgery and how well you follow it.

Talk to your surgeon about his or her surgical experience and success rate with the technique that would best treat your condition.

Risks

The risks of Achilles tendon surgery include:

  • Skin infection at the incision site.
  • Normal complications of surgery or anesthesia, such as bleeding and side effects from medicines.
  • Nerve damage.
  • Risk of repeat Achilles rupture. This risk, though, is typically less than the risk after nonsurgical treatment.
  • The possibility that the healed tendon will not be as strong as before the injury.
  • Decreased range of motion.

What To Think About

An Achilles tendon rupture is usually treated with surgery or with a cast, splint, brace, or other device that will keep your lower leg from moving (immobilization). When compared with immobilization, surgery provides less chance that the tendon will rupture again and offers a shorter recovery period. There is greater risk for wound complications in surgery, though.

Click here to view a Decision Point.Achilles Tendon Rupture: Should I Have Surgery?

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Khan RJ, et al. (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
  2. Wong J, et al. (2002). Quantitative review of operative and nonoperative management of Achilles tendon ruptures. American Journal of Sports Medicine, 30(4): 565–575.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine
Last Revised January 3, 2011

Last Revised: January 3, 2011

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine

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