Achilles Repair
The Achilles is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone. When it ruptures, the connection between calf and heel is lost, and pushing off from the foot becomes difficult or impossible.
An Achilles repair is an operation to bring the torn ends of the tendon back together so they can heal in the correct position and at the correct length. Not every rupture requires surgery, and the decision is an important one worth understanding properly.
Do all Achilles ruptures need surgery?
No. Achilles ruptures can be treated either surgically or non-surgically, and modern non-surgical treatment using a structured programme of casting or bracing with early controlled movement produces good results for many people.
Both approaches have similar rates of return to activity in most patients. The main differences are:
Re-rupture: Higher with non-surgical treatment, though the difference has narrowed considerably with modern functional rehabilitation protocols.
Wound and infection risk: Present with surgery, absent without it. The skin over the Achilles is thin with a modest blood supply, which makes wound problems a genuine consideration.
Tendon length and strength: Without surgery the tendon can heal longer than its original length, which puts the calf at a mechanical disadvantage and may leave some reduction in push-off strength. Surgery allows the ends to be brought together directly, which helps restore the correct tension.
Surgery is more often recommended for younger and more active patients, for those wanting to return to demanding sport, where the rupture is not recent, or where imaging shows a large gap between the tendon ends. Non-surgical treatment is often preferred where wound healing is a concern, including in people who smoke or have diabetes or vascular disease.
What does the operation involve?
The repair is usually performed as day surgery under anaesthetic. The torn ends of the tendon are identified and stitched together with strong sutures, restoring the correct tension.
Recovery
Recovery follows a staged programme, and modern protocols favour early controlled movement rather than prolonged immobilisation:
First two weeks: The ankle is protected in a plaster or boot with the foot pointed downwards to take tension off the repair. Elevation is important for wound healing and swelling.
Two to six weeks: Progressing through a boot with heel wedges that are gradually reduced, bringing the ankle towards a neutral position. Weight-bearing is introduced as advised.
Six to twelve weeks: Out of the boot into supportive footwear, with physiotherapy focused on restoring calf strength and normal walking.
Three to six months: Building strength and control, progressing towards running and sport-specific work.
Six to twelve months: Return to full sport for most people. Calf strength is often the last thing to recover fully and may take a year or more.
Risks
As with any operation there are risks, which will be discussed with you beforehand. These include infection, wound healing problems, blood clots, injury to the sural nerve causing numbness along the outer foot, and re-rupture. Wound complications are the risk most specific to this operation because of the thin skin over the tendon. Smoking substantially increases that risk.
Dr Janan's approach
Dr Janan completed fellowship training in Bristol, a major United Kingdom foot and ankle centre, and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot. He treats Achilles ruptures both surgically and non-surgically, and uses minimally invasive repair techniques where they are appropriate.
Because both pathways are genuinely available here, the discussion is about which suits your tendon, your health and your goals — not about whether to operate as a default.
Recently ruptured your Achilles?
Book a consultation with Dr Janan Chandrananth — early assessment gives you the widest range of treatment options.
FAQs
How quickly do I need to be seen?
Soon. Achilles ruptures are best assessed early, ideally within the first week or two. As time passes the tendon ends retract and the gap widens, which narrows the treatment options and can make surgery more complex. If you suspect a rupture, seek assessment promptly rather than waiting to see whether it settles.
How do I know if it is ruptured rather than just strained?
A rupture often produces a sudden sharp pain at the back of the ankle, sometimes with an audible snap, and many people describe feeling as though they have been kicked. Pushing off or standing on tiptoe on that leg is usually difficult or impossible. A strain is generally more gradual and does not produce that loss of power. Examination and ultrasound confirm the diagnosis.
Will surgery get me back to sport faster?
Not markedly. Return to sport takes several months either way because the tendon needs time to heal and calf strength needs to be rebuilt. Surgery is chosen for reasons such as re-rupture risk, gap size and timing rather than for speed.
Will my calf be as strong as before?
Most people regain very good function, but some reduction in calf strength compared with the other side is common and can persist. This is one of the areas where consistent rehabilitation makes the greatest difference, well beyond the point at which walking feels normal.
What is the chance of it rupturing again?
Re-rupture is uncommon after surgery but can occur. Most re-ruptures occur in the early months, which is why following the weight-bearing and activity advice matters.
Can it be repaired if the injury happened weeks ago?
Often yes, but delayed repair is more complex because the tendon ends retract over time. Also the results are not as good with a delayed repair. Sometimes additional tissue is required to bridge the gap. This is a further reason to be assessed early rather than waiting.
Related reading: Achilles Rupture