Achilles Tendon Rupture Treatment With or Without Surgery

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The Achilles tendon connects the calf muscles to the heel bone. It is the strongest tendon in the body, but it can rupture during explosive movements such as sprinting, jumping or pushing off, most often in recreational athletes in their thirties and forties. Most people feel a sudden “pop,” as if they were kicked in the back of the ankle, followed by pain and difficulty walking.

The key point: for most acute Achilles ruptures, you do not have to have surgery to get a good result. Non-surgical treatment with early, protected weight bearing and an accelerated rehabilitation program is a proven, appropriate option, with re-rupture rates similar to surgery and without the risks of an operation.

Dr. Dold’s published research

Acute Achilles Tendon Ruptures: An Update on Current Management Strategies

Andrew P. Dold, MD. Journal of the American Academy of Orthopaedic Surgeons (JAAOS). 2025;33(16):881–889.

In this review article, Dr. Dold brings together the research on treating a torn Achilles tendon: surgery versus non-surgical care, accelerated rehabilitation, minimally invasive repair and PRP. This page is based on that review and the 35 studies it cites.

Key findings · All 35 references · Read the article

Symptoms

A sudden pop or snap in the back of the ankle or calf
Sharp pain, then swelling and bruising above the heel
Weakness pushing off, trouble walking or standing on tiptoe
Sometimes a gap you can feel in the tendon

An Achilles rupture should be seen promptly. Early treatment matters, whether or not surgery is chosen.

Diagnosis

Dr. Dold can usually diagnose a rupture with a history and exam, including the calf-squeeze (Thompson) test. X-rays rule out a fracture. Dr. Dold will generally order an ultrasound or MRI with the ankle pointed down (plantar flexed) to measure the gap between the tendon ends. The size of that gap is one of the most important factors in predicting whether non-surgical treatment is likely to succeed.

The treatment decision also depends on patient factors (age, activity level, medical conditions) and injury factors (complete or partial tear, open or closed injury, the gap between the tendon ends).

Surgery or no surgery? What the research shows

For many years, surgery was the standard treatment because older studies showed higher re-rupture rates when the tendon was treated in a cast. That picture has changed. When non-surgical treatment uses early weight bearing and accelerated functional rehabilitation instead of long periods in a cast, research shows:

Re-rupture rates similar to surgical repair
Comparable strength, motion and return to activity for most patients
No risk of surgical complications such as wound infection, scar adhesion or injury to the sural nerve

A landmark randomized trial by Willits and colleagues at Western University in Canada (Journal of Bone and Joint Surgery, 2010) was among the first to show this. Dr. Dold’s 2025 review in the Journal of the American Academy of Orthopaedic Surgeons brings together the research since then (see below).

Non-surgical treatment: Dr. Dold’s accelerated rehabilitation program

Non-surgical treatment is not “doing nothing.” It is a structured, closely supervised program. In general:

First 2 weeks: a walking boot with heel lifts keeps the foot pointed down so the tendon ends stay together. You use crutches and don’t put weight on the leg.
From about 2 weeks: physical therapy begins, with protected weight bearing in the boot.
From about 4 weeks: weight bearing as tolerated in the boot, with the heel lifts gradually lowered.
About 8 to 12 weeks: you wean out of the boot into a regular shoe.
After 12 weeks: strength, power and sport-specific training.

Your plan is tailored to you, and Dr. Dold and your therapist follow your progress closely, including watching for blood clots.

When surgery may be recommended

Surgery remains a good option for some patients, such as certain high-level athletes and patients who prefer surgery after discussing the options with Dr. Dold. There are a variety of surgical options to consider, from minimally invasive (percutaneous and mini-open) techniques to a traditional open repair. Dr. Dold will recommend the right option for you based on your goals and the patient and injury factors described above. The same accelerated rehabilitation principles are used after surgery.

Watch Dr. Dold explain Achilles tendon ruptures

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Recovery and return to sport

With either treatment, most patients are walking in a regular shoe by about 3 months. Return to running usually takes about 4 to 5 months, and return to sport about 6 to 9 months, depending on strength testing and the demands of your sport.

Dr. Dold’s research on Achilles ruptures

Dold AP. Acute Achilles Tendon Ruptures: An Update on Current Management Strategies. Journal of the American Academy of Orthopaedic Surgeons. 2025;33(16):881–889. Read the article (doi:10.5435/JAAOS-D-24-00275)

In this review, Dr. Dold examined the research comparing surgical and non-surgical treatment. Key findings, in plain language:

With early weight bearing and accelerated rehabilitation, non-surgical treatment has re-rupture rates comparable to surgery.
Surgery carries risks that non-surgical care avoids, including infection, scar adhesion and sural nerve injury.
Newer minimally invasive surgical techniques reduce some surgical complications compared with traditional open repair.
Evidence for adding orthobiologics such as platelet-rich plasma (PRP) is mixed. Dr. Dold can discuss whether they have a role in your treatment.
There is no single right treatment for everyone. Patients should understand the benefits and risks of each option and choose the plan that fits their goals.

All 35 studies cited in the review are listed, with PubMed links, under Research cited on this page at the bottom of this page.

You can also read “I tore my Achilles tendon. Do I need surgery?” on our blog.

Why see Dr. Dold

Author of Acute Achilles Tendon Ruptures: An Update on Current Management Strategies, Journal of the American Academy of Orthopaedic Surgeons (JAAOS), 2025
Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
Fellow of the American Orthopaedic Association (FAOA), the American Academy of Orthopaedic Surgeons (FAAOS), the American College of Surgeons (FACS) and the Royal College of Surgeons of Canada (FRCSC)
Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google

Have more questions? See Achilles Tendon Rupture: 48 Questions Patients Ask, with Dr. Dold’s full accelerated rehabilitation protocol, the research on surgery vs non-surgical treatment, and videos.

Same-day appointments available. Request an appointment or call 469-850-0680. Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.

Frequently asked questions

Do I need surgery for a torn Achilles tendon?

Not necessarily. For most acute ruptures, non-surgical treatment with early weight bearing and accelerated rehabilitation is a proven option with re-rupture rates similar to surgery. Some patients are better served by surgery, and Dr. Dold will go over the options with you.

Is non-surgical treatment of an Achilles rupture as good as surgery?

Research using modern accelerated rehabilitation protocols shows comparable re-rupture rates and similar function for most patients, without surgical risks such as infection or nerve injury.

How long will I be in a boot after an Achilles rupture?

Typically about 8 to 12 weeks, starting with heel lifts and crutches, then gradually increasing weight bearing before weaning into a regular shoe.

How long does it take to recover from an Achilles rupture?

Most patients are walking in a regular shoe by about 3 months. Return to running usually takes about 4 to 5 months, and return to sport about 6 to 9 months, depending on strength testing.

How soon should I see a doctor after an Achilles rupture?

As soon as possible, ideally within the first few days. Starting treatment early is important whether or not you have surgery.

Research cited on this page

These are the 35 studies cited in Dr. Dold’s review, listed in the order they appear in the article.

Dold AP. Acute Achilles Tendon Ruptures: An Update on Current Management Strategies. J Am Acad Orthop Surg. 2025;33(16):881–889. doi:10.5435/JAAOS-D-24-00275 · PubMed

Alcelik I, Saeed ZM, Haughton BA, et al.: Achillon versus open surgery in acute Achilles tendon repair. Foot Ankle Surg 2018;24:427-434. PubMed
Myhrvold SB, Brouwer EF, Andresen TKM, et al.: Nonoperative or surgical treatment of acute achilles’ tendon rupture. N Engl J Med 2022;386:1409-1420. PubMed
She G, Teng Q, Li J, Zheng X, Chen L, Hou H: Comparing surgical and conservative treatment on achilles tendon rupture: A comprehensive metaanalysis of RCTs. Front Surg 2021;8:607743. PubMed
Deng S, Sun Z, Zhang C, Chen G, Li J: Surgical treatment versus conservative management for acute achilles tendon rupture: A systematic review and meta-analysis of randomized controlled trials. J Foot Ankle Surg 2017;56:1236-1243. PubMed
Ecker TM, Bremer AK, Krause FG, Müller T, Weber M: Prospective use of a standardized nonoperative early weightbearing protocol for achilles tendon rupture: 17 years of experience. Am J Sports Med 2016;44:1004-1010. PubMed
Ochen Y, Beks RB, van Heijl M, et al.: Operative treatment versus nonoperative treatment of achilles tendon ruptures: Systematic review and meta-analysis. BMJ 2019;364:k5120. PubMed
Park SH, Lee HS, Young KW, Seo SG: Treatment of acute achilles tendon rupture. Clin Orthop Surg 2020;12:1-8. PubMed
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M: Surgical versus nonsurgical treatment of acute achilles tendon rupture: A metaanalysis of randomized trials. J Bone Joint Surg Am 2012;94:2136-2143. PubMed
Jamjoom BA: The influence of early weightbearing, controlled motion, and timing of orthosis removal on the nonoperative management of achilles tendon rupture: A systematic review. J Foot Ankle Surg 2021;60:777-786. PubMed
Möller M, Movin T, Granhed H, Lind K, Faxén E, Karlsson J: Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 2001;83:843-848. PubMed
Twaddle BC, Poon P: Early motion for achilles tendon ruptures: Is surgery important?: A randomized, prospective study. Am J Sports Med 2007;35:2033-2038. PubMed
Lim CS, Lees D, Gwynne-Jones DP: Functional outcome of acute achilles tendon rupture with and without operative treatment using identical functional bracing protocol. Foot Ankle Int 2017;38:1331-1336. PubMed
Dai W, Leng X, Wang J, Hu X, Ao Y: Rehabilitation regimen for nonsurgical treatment of achilles tendon rupture: A systematic review and metaanalysis of randomised controlled trials. J Sci Med Sport 2021;24:536-543. PubMed
Mark-Christensen T, Troelsen A, Kallemose T, Barfod KW: Functional rehabilitation of patients with acute achilles tendon rupture: A metaanalysis of current evidence. Knee Surg Sports Traumatol Arthrosc 2016;24:1852-1859. PubMed
Heikkinen J, Lantto I, Flinkkila T, et al.: Soleus atrophy is common after the nonsurgical treatment of acute achilles tendon ruptures: A randomized clinical trial comparing surgical and nonsurgical functional treatments. Am J Sports Med 2017;45:1395-1404. PubMed
Wang C, Fan H, Li Y, Yun Z, Zhang Z, Zhu Q: Effectiveness of platelet-rich plasma injections for the treatment of acute achilles tendon rupture: A systematic review and meta-analysis. Medicine (Baltimore) 2021;100:e27526. PubMed
Keene DJ, Alsousou J, Harrison P, et al.: Platelet-rich plasma injection for acute achilles tendon rupture: Two-year follow-up of the PATH-2 randomized, placebo-controlled, superiority trial. Bone Joint J 2022;104B:1256-1265. PubMed
Zou J, Mo X, Shi Z, et al.: A prospective study of platelet-rich plasma as biological augmentation for acute achilles tendon rupture repair. Biomed Res Int 2016;2016:9364170. PubMed
Boksh K, Elbashir M, Thomas O, Divall P, Mangwani J: Platelet-rich plasma in acute achilles tendon ruptures: A systematic review and metaanalysis. Foot (Edinb) 2022;53:101923. PubMed
Nordenholm A, Nilsson N, Senorski EH, Helander KN, Westin O, Olsson N: Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series. J Exp Orthop 2022;9:15. PubMed
Chen H, Ji X, Zhang Q, Liang X, Tang P: Channel-assisted minimally invasive repair of acute Achilles tendon rupture. J Orthop Surg Res 2015;10:167. PubMed
Martin KD, Crouser NJ, Khan IA: Minimally invasive mid-substance achilles tendon repair using the percutaneous achilles repair system (PARS). Essent Surg Tech 2022;12:e21.00050. PubMed
Aktas S, Kocaoglu B: Open versus minimal invasive repair with Achillon device. Foot Ankle Int 2009;30:391-397. PubMed
Hsu AR, Jones CP, Cohen BE, Davis WH, Ellington JK, Anderson RB: Clinical outcomes and complications of percutaneous achilles repair system versus open technique for acute achilles tendon ruptures. Foot Ankle Int 2015;36:1279-1286. PubMed
Clanton TO, Haytmanek CT, Williams BT, et al.: A biomechanical comparison of an open repair and 3 minimally invasive percutaneous achilles tendon repair techniques during a simulated, progressive rehabilitation protocol. Am J Sports Med 2015;43:1957-1964. PubMed
Heitman DE, Ng K, Crivello KM, Gallina J: Biomechanical comparison of the Achillon tendon repair system and the Krackow locking loop technique. Foot Ankle Int 2011;32:879-887. PubMed
Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P: Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs. Int Orthop 2012;36:1947-1951. PubMed
Attia AK, Mahmoud K, d’Hooghe P, Bariteau J, Labib SA, Myerson MS: Outcomes and complications of open versus minimally invasive repair of acute achilles tendon ruptures: A systematic review and metaanalysis of randomized controlled trials. Am J Sports Med 2023;51:825-836. PubMed
Jack RA, Sochacki KR, Gardner SS, et al.: Performance and return to sport after achilles tendon repair in national football league players. Foot Ankle Int 2017;38:1092-1099. PubMed
Del Buono A, Volpin A, Maffulli N: Minimally invasive versus open surgery for acute achilles tendon rupture: A systematic review. Br Med Bull 2014;109:45-54. PubMed
Bartel AFP, Elliott AD, Roukis TS: Incidence of complications after Achillon® mini-open suture system for repair of acute midsubstance achilles tendon ruptures: A systematic review. J Foot Ankle Surg 2014;53:744-746. PubMed
Ismail M, Karim A, Shulman R, Amis A, Calder J: The Achillon® achilles tendon repair: Is it strong enough? Foot Ankle Int 2008;29:808-813. PubMed
Joannas G, Arrondo G, Eslava S, et al.: Percutaneous Achilles tendon repair with the Dresden instrument. Clinical and MRI evaluation of 90 patients. Foot Ankle Surg 2020;26:209-217. PubMed
Manegold S, Tsitsilonis S, Schumann J, et al.: Functional outcome and complication rate after percutaneous suture of fresh Achilles tendon ruptures with the Dresden instrument. J Orthop Traumatol 2018;19:19. PubMed
Amlang MH, Christiani P, Heinz P, Zwipp H: The percutaneous suture of the Achilles tendon with the Dresden instrument. Oper Orthop Traumatol 2006;18:287-299. PubMed

Additional studies on Achilles rupture treatment (33)

Hurt your Achilles? Request an appointment online or call 469-850-0680. Our staff will contact you by phone and text within an hour of your request (during business hours, Monday–Friday, 8 am–5 pm). Walk-in visits are welcome Monday, Wednesday and Friday, 8:30–10:30 am.