You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
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The Achilles tendon connects the calf muscles to the heel bone. It is the biggest tendon in the human body, and it allows you to rise up on your toes while walking. It withstands a large amount of force with each foot movement.
An Achilles tendon rupture occurs when the tendon is completely torn in two. When this happens, your leg may be weak, and walking may be difficult. You may not be able to rise up on your toes.
Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon. It can be done with one large incision (open surgery) or many smaller incisions (percutaneous surgery).
Nonsurgical treatment starts with immobilizing your leg. This prevents you from moving the lower leg and ankle so that the ends of the Achilles tendon can reattach and heal. A cast, splint, brace, walking boot, or other device may be used to do this.
Both immobilization and surgery are often successful. They both help the tendon to heal. Another rupture is less likely after surgery than after immobilization, but immobilization has fewer other risks.
The success of your surgery depends on:
The risks of surgery are similar, whether you have percutaneous surgery or open surgery. The biggest risk of either type of surgery is wound infection. It is more common with open surgery. Your risk can also change depending on whether you begin walking and using your foot sooner after surgery rather than later. This is called early mobilization.
The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring.
With immobilization, the greatest risk is that the tendon will rupture again.
As with surgery, minor pain and temporary nerve damage are also risks when immobilization with a cast or brace is used. There is also a very slight risk of deep vein thrombosis or permanent nerve damage with nonsurgical treatment.
| Results of treatment | With surgery to repair | With immobilization (no surgery) |
|---|---|---|
| No problems with pain, shoes, or walking after 1 year | 73 out of 100 | 51 out of 100 |
| Return to sports at pre-injury level within 1 to 2 years | 69 out of 100 | 68 out of 100 |
| Re-rupture of tendon within 1 to 2 years | 5 out of 100 | 12 out of 100 |
| Deep wound infection | 2 to 3 out of 100 | 0 out of 100 |
*Based on the best available evidence (evidence quality: borderline to inconclusive)
When it comes to reducing problems with pain, wearing shoes, and walking, surgery may help more than treatment with a cast or brace. (The quality of the evidence about this is inconclusive.)
When it comes to helping people return to sports at the level they were before they got hurt, the results are about the same with or without surgery. (The quality of the evidence about this is borderline.)
No matter what kind of treatment you have, there is a chance that your Achilles tendon will rupture again. Evidence suggests that this may be less likely with surgery. (The quality of the evidence about this is borderline.)
Take a group of 100 people who have a ruptured Achilles tendon.
Achilles tendon surgery can sometimes cause a deep infection in the foot or leg. (The quality of the evidence about this risk is borderline.)
Out of 100 people who have the surgery, 2 to 3 of them will get a deep infection. This means that 97 to 98 will not.
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.footnote 1, footnote 2 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
Your doctor may advise you to have surgery if:
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These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I blew out my Achilles playing basketball—and we still lost! I've talked to my doctor about this, and he recommends surgery, as I want to continue playing basketball and am active in a lot of other ways. I'm going with an open surgery, because that seems to be the best for not having another rupture. I realize there is more of a possibility for wound infection, but that's worth the risk—I don't want to pop my Achilles again, and, to tell the truth, I don't really worry about infections.
Carlo, age 34
I don't really know how I did it, but I ruptured my Achilles tendon. I guess sometimes a simple action can do it. I don't like the idea of surgery, so I'm going with a cast and a good rehab program. Although I like to go for walks, I'm not an athlete by any means, so my doctor says I probably shouldn't have to worry about doing it again.
Marian, age 55
And I thought my injury days were over! I gave up playing sports a while back, but I still referee young children's soccer games. At the last one I did, whack, there went my Achilles. Now I have to decide what to do. I'm not overly active, but I still like to get around. I'm also getting to the point where surgery and potential complications bother me, but on the other hand, I really don't want another rupture. My doctor told me he knows a surgeon who is very experienced in a type of surgery that does not make a big cut—I believe it's called percutaneous surgery. This surgery is supposed to solidly fix the tendon but have less risk of complications. This sounds good to me, especially because the surgeon is experienced.
Brandi, age 45
I started jogging again after quite a few years, and a week later, blam!—out goes my Achilles. Talk about bad luck! My doc says surgery would be no problem, as I'm a young guy in good health. But surgery just bugs me. I'd rather have a cast, even if my doc says an operation gives me less risk of doing it again. But I've learned my lesson. After the cast comes off, I'll pay more attention to warming up and starting slowly with new activities. I won't be one of those guys who reruptures after using a cast!
Fred, age 33
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose surgery for a ruptured Achilles tendon
Reasons to choose a cast or brace (immobilization) to treat a ruptured Achilles tendon
I don't want to risk having another tendon rupture.
I'm willing to take the risk of having another tendon rupture if it means not having surgery.
My job requires that I have strong legs.
My job doesn't require that I have strong legs.
I'm not worried about the risks of surgery.
I'm worried about the risks of surgery.
I'm an active person, and I want to stay active.
I am not very active in my daily life, and being active is not that important to me.
I want to return to my normal activity levels as soon as possible.
The long recovery time does not bother me.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Surgery
Immobilization (no surgery)
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Anne C. Poinier MD - Internal Medicine |
| Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
| Primary Medical Reviewer | Adam Husney MD - Family Medicine |
| Primary Medical Reviewer | Kathleen Romito MD - Family Medicine |
| Primary Medical Reviewer | Davide Bardana MD, FRCSC - Orthopedic Surgery, Sports Medicine |
The Achilles tendon connects the calf muscles to the heel bone. It is the biggest tendon in the human body, and it allows you to rise up on your toes while walking. It withstands a large amount of force with each foot movement.
An Achilles tendon rupture occurs when the tendon is completely torn in two. When this happens, your leg may be weak, and walking may be difficult. You may not be able to rise up on your toes.
Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon. It can be done with one large incision (open surgery) or many smaller incisions (percutaneous surgery).
Nonsurgical treatment starts with immobilizing your leg. This prevents you from moving the lower leg and ankle so that the ends of the Achilles tendon can reattach and heal. A cast, splint, brace, walking boot, or other device may be used to do this.
Both immobilization and surgery are often successful. They both help the tendon to heal. Another rupture is less likely after surgery than after immobilization, but immobilization has fewer other risks.
The success of your surgery depends on:
The risks of surgery are similar, whether you have percutaneous surgery or open surgery. The biggest risk of either type of surgery is wound infection. It is more common with open surgery. Your risk can also change depending on whether you begin walking and using your foot sooner after surgery rather than later. This is called early mobilization.
The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring.
With immobilization, the greatest risk is that the tendon will rupture again.
As with surgery, minor pain and temporary nerve damage are also risks when immobilization with a cast or brace is used. There is also a very slight risk of deep vein thrombosis or permanent nerve damage with nonsurgical treatment.
| Results of treatment | With surgery to repair | With immobilization (no surgery) |
|---|---|---|
| No problems with pain, shoes, or walking after 1 year | 73 out of 100 | 51 out of 100 |
| Return to sports at pre-injury level within 1 to 2 years | 69 out of 100 | 68 out of 100 |
| Re-rupture of tendon within 1 to 2 years | 5 out of 100 | 12 out of 100 |
| Deep wound infection | 2 to 3 out of 100 | 0 out of 100 |
*Based on the best available evidence (evidence quality: borderline to inconclusive)
When it comes to reducing problems with pain, wearing shoes, and walking, surgery may help more than treatment with a cast or brace. (The quality of the evidence about this is inconclusive.)
When it comes to helping people return to sports at the level they were before they got hurt, the results are about the same with or without surgery. (The quality of the evidence about this is borderline.)
No matter what kind of treatment you have, there is a chance that your Achilles tendon will rupture again. Evidence suggests that this may be less likely with surgery. (The quality of the evidence about this is borderline.)
Take a group of 100 people who have a ruptured Achilles tendon.
Achilles tendon surgery can sometimes cause a deep infection in the foot or leg. (The quality of the evidence about this risk is borderline.)
Out of 100 people who have the surgery, 2 to 3 of them will get a deep infection. This means that 97 to 98 will not.
Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it.
The information shown here is based on the best available evidence.1, 2 The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive.
Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.
Your doctor may advise you to have surgery if:
| Have surgery for Achilles tendon rupture | Treat the rupture with a cast or brace (immobilization) | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"I blew out my Achilles playing basketball—and we still lost! I've talked to my doctor about this, and he recommends surgery, as I want to continue playing basketball and am active in a lot of other ways. I'm going with an open surgery, because that seems to be the best for not having another rupture. I realize there is more of a possibility for wound infection, but that's worth the risk—I don't want to pop my Achilles again, and, to tell the truth, I don't really worry about infections."
— Carlo, age 34
"I don't really know how I did it, but I ruptured my Achilles tendon. I guess sometimes a simple action can do it. I don't like the idea of surgery, so I'm going with a cast and a good rehab program. Although I like to go for walks, I'm not an athlete by any means, so my doctor says I probably shouldn't have to worry about doing it again."
— Marian, age 55
"And I thought my injury days were over! I gave up playing sports a while back, but I still referee young children's soccer games. At the last one I did, whack, there went my Achilles. Now I have to decide what to do. I'm not overly active, but I still like to get around. I'm also getting to the point where surgery and potential complications bother me, but on the other hand, I really don't want another rupture. My doctor told me he knows a surgeon who is very experienced in a type of surgery that does not make a big cut—I believe it's called percutaneous surgery. This surgery is supposed to solidly fix the tendon but have less risk of complications. This sounds good to me, especially because the surgeon is experienced."
— Brandi, age 45
"I started jogging again after quite a few years, and a week later, blam!—out goes my Achilles. Talk about bad luck! My doc says surgery would be no problem, as I'm a young guy in good health. But surgery just bugs me. I'd rather have a cast, even if my doc says an operation gives me less risk of doing it again. But I've learned my lesson. After the cast comes off, I'll pay more attention to warming up and starting slowly with new activities. I won't be one of those guys who reruptures after using a cast!"
— Fred, age 33
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose surgery for a ruptured Achilles tendon
Reasons to choose a cast or brace (immobilization) to treat a ruptured Achilles tendon
I don't want to risk having another tendon rupture.
I'm willing to take the risk of having another tendon rupture if it means not having surgery.
My job requires that I have strong legs.
My job doesn't require that I have strong legs.
I'm not worried about the risks of surgery.
I'm worried about the risks of surgery.
I'm an active person, and I want to stay active.
I am not very active in my daily life, and being active is not that important to me.
I want to return to my normal activity levels as soon as possible.
The long recovery time does not bother me.
My other important reasons:
My other important reasons:
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Surgery
Immobilization (no surgery)
1. I am less likely to rupture the tendon again if I have surgery than if I use a cast or brace.
2. Surgery has some risks that immobilization does not.
3. My job requires a lot of walking. Immobilization gives me the best chance of getting back to that without problems.
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Anne C. Poinier MD - Internal Medicine |
| Primary Medical Reviewer | E. Gregory Thompson MD - Internal Medicine |
| Primary Medical Reviewer | Adam Husney MD - Family Medicine |
| Primary Medical Reviewer | Kathleen Romito MD - Family Medicine |
| Primary Medical Reviewer | Davide Bardana MD, FRCSC - Orthopedic Surgery, Sports Medicine |
Current as of: March 9, 2022
Author: Healthwise Staff
Medical Review:Anne C. Poinier MD - Internal Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Davide Bardana MD, FRCSC - Orthopedic Surgery, Sports Medicine
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