An Achilles tendon tear is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a pop or a snap, and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and usually have swelling and bruising that quickly develops around the tendon.
Achilles tendon tears most often occur in young to middle-aged weekend warrior athletes. While sometimes occurring in younger athletes, or elderly individuals, these injuries are most common in men in their 30s and 40s. Typically this occurs during a pickup basketball or soccer game, and most often there were no symptoms of Achilles problems prior to the injury. When a tear occurs, the pain is sudden and severe. Walking can be difficult, and returning to athletics is out of the question.
Treatment Options for Torn Achilles Tendon
There are several options for torn Achilles tendon treatment. There is not necessarily a single best treatment, just a best option for each individual. Therefore, you should discuss the pros and cons of different treatment options for a torn Achilles tendon with your doctor. Treatments range from non-surgical to immediate surgery. Depending on a number of factors, your orthopedic surgeon can help you determine the most appropriate treatment.1
Some of the factors your surgeon may use to determine the chosen treatment include:
Smoking history (smokers have a higher chance of surgical complications)
Medical conditions (diabetics can have problems healing from surgery)
Surgery for Acute Achilles Tendon Tears
Surgery for an acute Achilles tendon tear is seemingly straightforward. The ends of the torn tendon are surgically exposed and sutures are used to tie the ends together. The sutures used to tie together the torn tendon ends are thick and strong and are woven into the Achilles both above and below the tear.
While the surgical concepts are straightforward, the execution is more complex. Care must be taken to ensure the tendon is repaired with the proper tension—not too tight or too loose. The skin must be taken care of, as excessive handling of the soft tissues can cause severe problems including infection and skin necrosis. Nerves located just adjacent to the tendon must be protected to prevent nerve injury.
Surgery is usually performed within days or weeks of the injury. The idea is to perform the repair before scar tissue has formed, which would make the repair more difficult.
Some surgeons may recommend delaying surgery until a few days after the initial injury to allow swelling to subside before proceeding with the repair.
Surgeons differ on how they perform Achilles tendon repairs. It is becoming more popular to perform a surgical repair through smaller incisions, or even percutaneous incisions.2 The benefit of these minimally invasive surgical techniques is that there is less damage to the surrounding soft tissues. This means less pain after surgery and a faster recovery.
However, some surgeons will argue that the repair strength is the most important factor, and surgical incision size should not be prioritized over the strength of the repair. If you have questions about how invasive a surgery is planned, you should discuss this with your surgeon.
Surgery for Chronic Achilles Tendon Tears
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can become more complicated.3
Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore the function of the Achilles.
The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore the function of a chronically damaged Achilles.
The recovery following chronic Achilles tendon tear surgery can take longer than it typically would for someone who had their tear treated soon after the initial injury.4 Part of the reason the recovery process takes longer is that your surgeon may have to be more cautious given the tension on the repair tissue. For this reason, you may be immobilized for a longer period of time, and it may ultimately take longer to regain mobility. In addition, chronic Achilles injuries tend to lead to atrophy of the musculature. Regaining muscle strength and function will take longer than in people who had their Achilles tendon rupture treated soon after the injury.
Rehab After Surgery
There are many rehabilitation protocols following surgery for an Achilles tendon tear. Most surgeons encourage the use of protection including walking boots or splints, but also urge patients to start early motion. Studies have demonstrated that motion can be started immediately following surgery, but protection is needed while walking. In patients at higher risk for complications, immobilization with a cast may be continued for several weeks or longer.
In general, most patients return to walking in 4 to 6 weeks,5 strengthening after about 8 weeks, and exercising at 3 months. Most patients who are athletes do not return to their sport for about 6 months, and many can take longer to fully recover from Achilles surgery.
A Word From Verywell
Surgery is an option for treatment of an Achilles tendon tear. While nonsurgical treatment has shown some good results, most athletically active individuals will choose to have surgical treatment for a torn Achilles tendon. The surgical treatment itself is relatively straightforward, but the recovery process takes a minimum of 6 months for people to return to full activity, and it is not uncommon for full return to preinjury level of activity to take the year. Complications of surgery including infection and wound healing problems can occur, but with careful attention to the postoperative management of these injuries, the chance of these complications is small.