Achilles tendon repair (Surgical repair of a ruptured Achilles tendon)
An operation to sew back together a snapped (ruptured) Achilles tendon at the back of the ankle, used for some people instead of healing the tendon in a boot.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Achilles repair stitches a snapped heel-cord tendon back together; it is one option, and many ruptures heal well in a boot without surgery.
- Surgery lowers the chance of the tendon snapping again compared with non-surgical treatment, but it adds risks such as wound problems and nerve injury.
- Recovery is long either way: weeks in a boot, then months of physiotherapy, with return to sport often 4–12 months away.
- Choose a surgeon who does foot and ankle work regularly and who explains why surgery rather than a boot is right for your specific injury.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Stitches the torn tendon ends back together so they heal in a good position
People for whom the risks of surgery and anaesthetic outweigh the benefit, where treatment in a boot is safer.
The leg is in a cast or boot with the foot pointing down. Keep it elevated to reduce swelling, use crutches, and follow advice on weight-bearing and clot...
A clear, staged boot and physiotherapy plan, with named contacts.
The leg is in a cast or boot with the foot pointing down. Keep it elevated to reduce swelling, use crutches, and...
You stay in a boot, often with the foot angle gradually brought up and heel wedges removed in stages. You are...
You are typically weaned out of the boot into normal shoes and begin more active physiotherapy. The tendon takes...
Strengthening continues. Calf strength and balance gradually improve, but the injured side often still lags behind...
What is an Achilles tendon repair?
The Achilles tendon is the thick cord at the back of your ankle that joins your calf muscles to your heel bone. It lets you push off when you walk, run or stand on tiptoe. A sudden rupture often happens during sport, and many people feel a snap and think they have been kicked or hit in the back of the leg.
Achilles tendon repair is an operation that stitches the two torn ends of the tendon back together. It is one of two main ways to treat a rupture. The other is non-surgical treatment, where the tendon is allowed to heal on its own inside a special boot or cast that holds the foot pointing downwards.
In the UK, most ruptures are now treated without surgery, because good-quality studies show the healing and function can be similar to surgery, without the risks that come with an operation. Surgery is more often considered for certain people, such as some younger or very active patients, or where the tendon ends are far apart. The decision should be made with a foot and ankle surgeon, weighing your activity, your general health and the specific injury.
Surgery does not make you heal faster. Whichever path you take, the tendon is slow to heal and the overall recovery takes many months.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Surgery versus healing in a boot
| Surgery | Boot (non-surgical) | |
|---|---|---|
| Re-rupture risk | Lower | Slightly higher |
| Wound and nerve risks | Yes | Avoided |
| Anaesthetic needed | Yes | No |
| Overall recovery | Long | Long, similar |
Modern boot (functional rehabilitation) protocols have narrowed the difference in re-rupture rates. Your surgeon will explain what suits your injury and activity.
Preparing for your surgery
- See a foot and ankle surgeon, who will confirm the rupture by examining the calf and tendon, sometimes with an ultrasound or MRI scan.
- Ask why surgery is being advised rather than treatment in a boot, as both are reasonable for many people.
- Tell the team about diabetes, smoking, steroid use or any condition affecting wound healing, as these raise the risk of wound problems.
- Stop smoking if you can, as smoking increases wound and healing complications.
- Plan for being off your feet: you will not be able to drive or weight-bear normally for some time, so arrange transport, time off work and help at home.
- Set up your home so you can manage on crutches or a knee scooter, with things you need within easy reach.
- Discuss blood-clot prevention, as being in a boot and less mobile raises the risk of a clot in the leg.
What happens
The operation is usually done under a general anaesthetic or a spinal/regional block, often as a day case, so most people go home the same day.
You will normally lie face down. The surgeon makes a cut (or several small cuts) at the back of the ankle, brings the torn tendon ends together and stitches them securely. The wound is closed and your leg is put into a plaster cast or a boot with the foot pointing downwards to take tension off the repair.
The operation itself usually takes around 45–60 minutes. Afterwards you will be shown how to keep the leg elevated and how to move safely on crutches before you go home.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- People for whom the risks of surgery and anaesthetic outweigh the benefit, where treatment in a boot is safer.
- Those with poor skin or circulation at the back of the ankle, or uncontrolled diabetes, where wound healing is a major concern.
- Current smokers who are unwilling to stop, given the higher wound-complication risk.
- People who expect surgery to speed up recovery or guarantee a return to elite sport.
Delay surgery if…
- There is active infection or a skin problem over the back of the ankle.
- You have a suspected or confirmed blood clot in the leg that needs treating first.
- Your general health or medication (for example blood thinners) needs optimising before surgery.
- A clear decision between surgery and a boot has not yet been made with a foot and ankle surgeon.
Alternatives to discuss
- Non-surgical (functional) treatment in a boot or cast, the usual UK approach for many ruptures.
- Watchful, supported rehabilitation under a physiotherapist as the tendon heals.
- For old or re-ruptured tendons, more complex reconstruction with tendon transfer or graft.
- Treating the rupture on the NHS rather than privately, as both pathways are available.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Stitches the torn tendon ends back together so they heal in a good position
- Lowers the chance of the tendon rupturing again compared with non-surgical treatment
- May be preferred where the tendon ends are widely separated or the rupture is found late
- Can be the right choice for some highly active people, after weighing the added risks
Risks & complications
- Pain, swelling and bruising around the ankle that settle over weeks
- A scar at the back of the ankle
- Stiffness and weakness in the calf and ankle that take months of physiotherapy to improve
- A long period of reduced mobility and being unable to drive
- Wound-healing problems or a wound infection, more likely with open surgery
- Numbness or altered feeling over part of the foot from irritation of the sural nerve
- A blood clot in the leg (deep vein thrombosis), which can occasionally travel to the lungs
- The repaired tendon healing slightly long or short, affecting push-off power
- The tendon rupturing again, even after a successful repair
- A deep infection involving the tendon, which can need further surgery
- Problems related to the anaesthetic
The most important specific trade-off is wound healing: open Achilles surgery carries a higher rate of wound problems and infection than non-surgical treatment, and these can be serious because the skin over the tendon is thin. Smoking and diabetes increase this risk. Ask your surgeon how they reduce wound and nerve complications, and how they will prevent blood clots while you are less mobile.
Published figures to discuss
Reported rates vary with the technique (open versus minimally invasive), the rehabilitation protocol, and patient factors such as smoking and diabetes. The figures below are cautious ranges from systematic reviews and should be read as general guidance, not a personal prediction. The clearest, consistent finding is that surgery lowers re-rupture risk compared with non-surgical treatment, while adding wound and nerve risks.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Re-rupture after surgical repair | Low single figures (often reported around 2–4%), and generally lower than after non-surgical treatment | Rates vary with rehabilitation protocol; non-surgical treatment reports somewhat higher re-rupture rates in many studies. | Long-term outcomes after surgical repair of Achilles rupture — systematic review (PMC)ncbi.nlm.nih.govPublished figure |
| Wound infection after open repair | Roughly in the low single figures, and higher for open than minimally invasive surgery | Open surgery carries a clearly higher wound-complication rate than minimally invasive repair or non-surgical treatment; smoking and diabetes increase risk. | Long-term outcomes after surgical repair of Achilles rupture — systematic review (PMC)ncbi.nlm.nih.govSource-linked context |
| Sural nerve injury | Uncommon, reported more often with percutaneous than open techniques | Usually causes numbness over part of the foot; exact rates vary by technique and series. | Long-term outcomes after surgical repair of Achilles rupture — systematic review (PMC)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from an Achilles repair is long and gradual whatever the treatment. Expect weeks in a boot or cast, then a structured physiotherapy programme over several months to rebuild strength.
- Swelling and bruising around the ankle and foot in the early weeks
- A weak, wasted-looking calf that slowly rebuilds with physiotherapy
- Stiffness and a feeling of tightness as you come out of the boot
- Tiredness and frustration at how long the recovery takes
Aftercare
- Keep the leg elevated in the early days to control swelling.
- Keep the cast or boot dry and wear it exactly as instructed, including at night if told to.
- Take blood-clot prevention as advised and stay alert for calf pain, swelling or breathlessness.
- Use crutches or a knee scooter and only put weight through the leg as your team allows.
- Go to your physiotherapy appointments and do your home exercises, as these drive your recovery.
- Do not return to driving until you can safely control a vehicle and your team confirms it is allowed.
- Keep wound-check and follow-up appointments so healing and tendon position are monitored.
- Crutches or a knee scooter ready at home
- A plan for getting home without driving
- Time off work arranged (longer if your job is physical or on your feet)
- Help at home for the first weeks
- A waterproof cover for showering with the boot or cast
- The clinic's contact number saved for wound or clot concerns
Scars and how they heal
Open repair leaves a scar at the back of the ankle, usually a few centimetres long; minimally invasive repair uses smaller cuts. Because the skin here is thin and under tension, scars can occasionally be slow to heal, thickened or sensitive. Protect the area, follow wound-care advice and report any redness, gaping or discharge promptly.
⚠ Get urgent help if…
- Calf pain, swelling, warmth or redness, or sudden breathlessness or chest pain — possible blood clot, seek urgent help
- Spreading redness, heat, increasing pain or discharge from the wound — possible infection
- The wound opening up or the edges separating
- A sudden 'pop', giving way or loss of push-off power, which may mean the tendon has re-ruptured
- A high temperature or feeling generally unwell after surgery
- Severe or worsening pain not controlled by your usual painkillers
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the tendon heals in continuity and you regain the ability to walk, climb stairs and gradually return to activity, with re-rupture being uncommon after surgery. Even so, many people notice the injured calf stays a little weaker than the other side for a long time, and not everyone returns to their exact pre-injury level of sport.
Surgery does not guarantee a better functional result than treatment in a boot; its main advantage is a lower re-rupture rate. The final outcome depends heavily on completing rehabilitation.
Once healed, a repaired Achilles tendon is generally durable for everyday life. The tendon can rupture again, although this is uncommon, and a second rupture or injury to the other Achilles is possible later, especially with high-impact sport. Keeping calf muscles strong and flexible helps protect the tendon long term.
Combining with other procedures
Achilles repair is usually done on its own. Where a rupture is old or the tendon has snapped again, the surgeon may add a tendon transfer or graft to reinforce the repair, which lengthens the operation and recovery.
Follow-up & long-term care
You will normally be reviewed to check the wound and remove stitches, then at intervals as the boot angle is adjusted and you progress through physiotherapy. Tell your team straight away about wound problems, calf pain or any sudden loss of tendon function.
- Keep up calf-strengthening and stretching exercises after formal physiotherapy ends.
- Warm up properly and build training gradually when returning to sport.
- Be cautious with sudden explosive activities while strength is still returning.
Revision and secondary surgery reality
- If the tendon ruptures again, repeat surgery is more complex and may need a tendon transfer or graft.
- A repair that heals too long or too short can affect push-off power and occasionally needs further treatment.
- Wound-healing problems can require dressings, antibiotics or, rarely, further surgery.
- Final strength and function are judged over many months, not weeks.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A clear, staged boot and physiotherapy plan, with named contacts.
- Active blood-clot prevention and clear advice on clot warning signs.
- Prompt review of any wound concern, given the thin skin over the tendon.
- Honest discussion about expected strength, return to sport and the chance of re-rupture.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The surgeon's fee and whether an open or minimally invasive technique is used
- Anaesthetic fee and type (general, spinal/regional or local)
- Theatre and facility fees
- Imaging such as ultrasound or MRI to confirm the rupture
- Boot or cast, crutches and clot-prevention medicines
- The full course of physiotherapy, which is a major part of recovery
- Follow-up appointments and any treatment if complications occur
- The operating surgeon's fee
- Anaesthetist's fee and the type of anaesthetic
- Theatre and facility fees, and any overnight stay
- Boot/cast, crutches and blood-clot prevention
- How many physiotherapy sessions are included and the cost of further ones
- Follow-up appointments and wound checks
- What happens, and who pays, if a complication or re-rupture occurs
On the NHS? Both surgical repair and non-surgical boot treatment for a ruptured Achilles tendon are widely available on the NHS; private care is sometimes chosen for speed or choice of surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being told that treatment in a boot is a reasonable alternative for many ruptures.
- Surgery presented as faster recovery, when the overall timeline is long either way.
- No clear discussion of wound, nerve and clot risks specific to Achilles surgery.
- No written rehabilitation and clot-prevention plan before the operation.
Marketing red flags
- Claims that surgery guarantees a return to full sporting performance.
- Describing the operation as quick or simple without explaining the long recovery.
- Pushing surgery without discussing non-surgical treatment.
- No mention of wound problems, nerve injury or blood-clot risk.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- For my specific injury, would treatment in a boot give a similar result to surgery?
- Why are you recommending surgery rather than non-surgical treatment?
- Will you use an open or minimally invasive technique, and why?
- How will you protect the sural nerve and reduce wound problems?
- What is my personal risk of the tendon rupturing again?
- What will my boot and physiotherapy timeline look like, week by week?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do I definitely need surgery for a ruptured Achilles?
Is surgery available on the NHS?
How long until I can walk and drive again?
Will my calf be as strong as before?
Can the tendon snap again after surgery?
Why does recovery take so long?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: BOFAS — Patient guide to Achilles tendon ruptures NHS (Cambridge University Hospitals) — Achilles tendon rupture: management and rehabilitation Rerupture: conservative vs open vs minimally invasive repair — systematic review (PMC) Infection and rerupture after surgical repair of Achilles tendons (PMC) Long-term outcomes after surgical repair of Achilles rupture — systematic review (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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