Achilles Tendon Ruptures

Surgical repair, or conservative management?


Muscle force through the Achilles tendon provides the “spring in our step.” These forces are huge even with routine walking, so it’s no wonder that Achilles tendon ruptures are common.

How are Achilles tendon ruptures treated?

The great debate of the past few decades has been whether it is better to treat a rupture surgically or non-surgically. While some tendons in the human just won’t heal without surgical help, the Achilles tendon can heal well without surgery if treated properly. (There is a strict non-surgical treatment protocol that must be followed.) There are even recent studies that suggest surgery might not offer any better results. So why are so many surgeons still performing Achilles repair surgery?

Most modern research studies say the biggest benefit of Achilles tendon repair surgery is a lower chance of re-rupturing the tendon in the future. But the reality is that a re-rupture is very uncommon either with or without surgery. The most important "take home" point from these research studies is that most patients (both surgical and non-surgical) have not reached their full strength and are still recovering at 6 months after injury.

What we know about Achilles tendon ruptures:

  • Full recovery takes a long time, more than 6 months, especially when thinking about return to high-level athletics.
  • Surgery offers a slightly faster start to the rehab process, and a slightly faster overall healing time, although the times are long either way.
  • Surgery takes away some of the uncertainty.

That last point is the most important. The vast majority of patients that have a successful tendon repair surgery will make a great recovery (full athletic participation). Many non-surgical patients will get there too, but a small number of non-surgical patients will not get their full strength back. They may be missing some strength, which will be noticeable with athletics. An even smaller number of non-surgical patients may even have a limp. The numbers are small, but those are some pretty frustrated patients.

How should patients decide what's right for them?

The foot and ankle team at Columbia Orthopedics has performed hundreds of Achilles tendon repair surgeries, with no subsequent, and extremely rare cases of re-ruptures in any sport following repair. While the non-surgical option is used in about one quarter of cases, this route is typically selected by patients with more limited athletic goals. It’s the doctor’s job to provide an acurate diagnosis and the facts about all available options. In the end, patients to know the issues and facts, and then make the right decision for their personal goals.