What is the Achilles Tendon?
The Achilles tendon is the thick, strong band of tissue that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It plays a vital role in everyday movement, allowing you to walk, run, jump, climb stairs, and stand on your toes.
As the calf muscles contract, they pull on the Achilles tendon, which pushes the foot downward. Each step places significant stress on the tendon — sometimes up to 12 times a person’s body weight during sprinting or jumping.
Because of this, the Achilles tendon is the most commonly injured tendon in the foot and ankle.
What is an Achilles Tendon Injury?
The Achilles tendon is prone to several types of injury, most commonly Achilles tendinosis (degenerative thickening and pain) and Achilles tendon rupture (a partial or complete tear).
Ruptures can occur suddenly during sports or vigorous activity, but they may also happen after a simple stumble or due to weakened tissue. In some cases, the tendon may be injured as a result of medication side effects, laceration, or crush injury.
A rupture typically causes sudden pain at the back of the ankle and difficulty walking or standing on tiptoe. Diagnosis is usually straightforward, though scans may be required to confirm the extent of the injury.
Who is Achilles Tendon Surgery For?
Surgical repair is usually recommended for patients with a complete rupture or significant tear of the Achilles tendon, particularly those who are active or wish to return to sport.
Non-surgical treatment — such as casting or bracing — may be an option for people with partial tears, sedentary lifestyles, or medical conditions that make surgery higher risk. However, the chance of re-rupture is higher with non-operative treatment (up to 10–15%) compared to less than 3% after surgery.
Benefits of Achilles Tendon Repair
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Restored function: Reattaches the torn tendon to restore normal strength and movement.
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Pain relief: Reduces pain and instability in the ankle.
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Improved mobility: Enables walking, running, and climbing stairs once healing is complete.
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Lower re-rupture risk: Surgical repair has a significantly lower recurrence rate compared to casting alone.
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Return to activity: Allows most patients to regain pre-injury levels of activity after rehabilitation.
How is Achilles Tendon Surgery Performed?
Achilles tendon repair is performed through a small incision along the back of the ankle. The surgeon identifies the torn ends of the tendon and uses strong sutures to reattach them, restoring proper length and tension.
The incision is usually made slightly off-centre to minimise friction from shoes during recovery. The aim is to strike a balance between protection for healing and early movement to prevent stiffness and muscle loss.
Risks and Complications
While most patients recover well, as with any surgery, complications can occur. These may include:
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Infection at the incision site (prevented with antibiotics).
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Nerve or blood vessel injury (rare).
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Re-rupture of the tendon (approximately 3 in 100 cases).
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Wound healing issues or scar tenderness.
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Anaesthetic-related complications (very rare).
There is also an increased risk of rupture in the opposite Achilles tendon in the future. Patients who have had one rupture should take extra care and may need to modify participation in high-impact sports.
Before and After Surgery
Before surgery
A full medical assessment will be completed to confirm that surgery is appropriate. You should inform your surgeon about all medications, supplements, and any history of bleeding disorders or poor wound healing. Surgery should be performed soon after injury for the best outcome.
Surgery
The procedure is carried out under general or spinal anaesthetic and typically takes around one hour. A plaster cast is applied from the knee to the toes with the foot pointing down to relax the tendon. You’ll use crutches and remain non-weight-bearing until your first follow-up appointment.
Recovery
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First 10 days: Keep the leg elevated and avoid putting weight on it. The plaster will be changed, and stitches removed after 10–12 days.
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Weeks 2–8: You may transition into a moon boot or lightweight cast. You’ll remain in this for about six to eight weeks.
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Pain and swelling: Some discomfort and swelling are normal for the first few days. Pain relief and elevation help reduce this.
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Return to work: Most patients can return to sedentary work after two months, though full recovery may take up to six months.
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Physiotherapy: A key part of recovery, physiotherapy helps restore flexibility and rebuild strength in the calf and ankle.
