Introduction: Setting the Scene

The Achilles tendon, the largest and strongest tendon in the body, connects your calf muscles to your heel bone, making it vital for walking, running and jumping. When this tendon ruptures , it can cause significant pain, weakness and mobility issues. This injury affects people of all ages, from sporty individuals to older adults. A common question following such an injury is whether it can heal without surgery. In this article, we explore non- surgical treatment options, compare them with surgical approaches, and highlight who might benefit most from each, helping you understand what to expect during recovery.

Understanding Achilles Tendon Ruptures

An Achilles tendon rupture occurs when the tendon is suddenly stretched beyond its capacity, often during a sudden push-off in sports or a misstep. Those affected typically experience a sharp, severe pain behind the ankle , swelling, difficulty walking and sometimes a gap or ‘hole’ where the tendon has torn. Treatment choices depend on several factors, including how large and where the tear is, the patient’s age, activity level, and overall health. For instance, a competitive athlete may require a quicker return to sport and hence a different approach compared to a less active older person.

How Does Non-Surgical Treatment Work?

Non- surgical treatment , also called conservative management, encourages the tendon to heal naturally. Initially, the foot and ankle are immobilised using specialised braces or walking casts that gently point the toes downwards (plantar flexion). This position reduces strain on the torn tendon ends, helping them to reconnect. Typically, this immobilisation lasts a number of weeks, during which weight-bearing on the leg is restricted or carefully controlled.

After immobilisation, physiotherapy plays a crucial role in recovery. A tailored rehabilitation programme helps patients regain ankle movement, rebuild calf muscle strength and restore normal walking patterns. This gradual return to activity helps prevent stiffness and muscle wasting, while supporting the healing tendon.

Evidence and Outcomes: Surgery Versus Conservative Care

Recent studies show that non-surgical treatment combined with functional rehabilitation tends to result in healing and overall function comparable to surgical repair. As Kanchanatawan and colleagues (2018) explain, “recent studies demonstrate that conservative treatment with functional rehabilitation provides good results, with nearly identical postoperative rerupture rates when compared with surgical treatment.”

Surgery is often recommended for younger, highly active people who need to return to their sport quickly or are concerned about muscle loss during immobilisation. Kanchanatawan et al. also point out that surgery is advised “for patients who are young active athletes who require early return to play or those who wish to avoid the muscle atrophy associated with conservative methods.”

Another surgical option, open Achilles tendon repair, involves making an incision at the back of the lower leg to directly stitch the tendon ends together. Moore and colleagues (2023) highlight that this method “is associated with a much faster return to activity/sport when compared with nonoperative alternatives,” which can be important for competitive athletes or those with delayed treatment.

Both surgical and non-surgical treatments can provide excellent outcomes when chosen appropriately, with patient commitment to rehabilitation being a key factor in successful recovery.

Risks, Benefits, and Choosing the Right Path

Choosing to avoid surgery has its own risks. Healing might be slower, and there is an increased chance the tendon could rupture again, leading to longer rehabilitation or need for surgery later on. Some people may also experience lasting weakness or reduced calf muscle strength.

On the other hand, non-surgical treatment removes risks associated with surgery such as infection, wound problems and nerve injuries. However, it’s important to understand that surgical options come with their own challenges. For instance, “In conventional open repair, the most common complication is soft-tissue infection... For percutaneous methods, sural nerve entrapment and injury are the most commonly reported complications” (Kanchanatawan et al., 2018).

Open surgery can provide a robust repair and quicker recovery for some patients. Moore et al. (2023) stress that “nonoperative and operative treatment of Achilles tendon rupture can both result in excellent patient outcomes. Appropriate patient selection is critical.” For athletes aiming to return to peak performance swiftly, surgery “is especially useful... to return to their previous activity level and functional capacity as quickly as possible.”

The Role of Expertise: Professor Paul Lee and MSK Doctors

Professor Paul Lee and the expert team at MSK Doctors bring specialist knowledge in treating Achilles tendon injuries. They take a personalised approach, carefully assessing each patient to recommend the best treatment path—whether surgical or conservative.

Their clinic combines thorough diagnosis, advanced treatment options, and closely monitored rehabilitation. Patients benefit from tailored guidance throughout recovery, helping to optimise outcomes and reduce chances of complications. The team’s expertise ensures you receive balanced and realistic advice suited to your particular situation.

Conclusion: Making an Informed Decision

To summarise, many patients can successfully heal a torn Achilles tendon without surgery, particularly when supported by careful immobilisation and rehabilitation. The choice between surgery and conservative care depends on individual factors, including age, activity levels, injury specifics and personal preferences.

If you or someone you know faces this injury, consulting a qualified healthcare professional is essential for personalised advice and effective recovery planning.

For individual medical advice, please consult a qualified healthcare professional.

References

Kanchanatawan, W., Densiri-aksorn, W., Maneesrisajja, T., Suppauksorn, S., Arirachakaran, A., Rungchamrussopa, P., & Boonma, P. (2018). Hybrid Achilles tendon repair. Arthroscopy Techniques, 7(6), e639-e644. https://doi.org/10.1016/j.eats.2018.02.011

Moore, M. L., Pollock, J. R., Karsen, P. J., Haglin, J. M., Lai, C., Elahi, M. A., Chhabra, A., O’Malley, M. J., & Patel, K. A. (2023). Open Achilles tendon repair. JBJS Case Connector, 13(1), e21.00054. https://doi.org/10.2106/jbjs.st.21.00054