A complete tear of the Achilles tendon usually occurs suddenly during sport, a sensation of being kicked in the back of the leg, followed by inability to push off. Surgical repair reconnects the torn ends; non-surgical treatment in a boot is also an option, with similar outcomes in many cases.
ℹ️ Acute Achilles rupture often requires surgery within 2 weeks of injury for best results. Pre-operative assessment is therefore relatively urgent.
You will meet the surgical and anaesthetic team. The choice between surgery and non-surgical treatment in a boot will be discussed in detail. Modern evidence shows both approaches give similar long-term outcomes when functional rehabilitation is used.
Standard pre-operative checks.
Blood thinners may need adjustment. Quinolone antibiotics should be avoided around the time of surgery.
Usually under general anaesthesia with a popliteal nerve block. Spinal anaesthesia is an alternative.
Tinzaparin or similar low-molecular-weight heparin injections are commonly prescribed for 4-6 weeks because of the increased DVT risk after Achilles injury.
You will be in a cast or boot with non-weight-bearing for 2 weeks. Arrange ground-floor sleeping and home help.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most foot and ankle surgery is performed as a day case, meaning you go home the same day. More complex procedures such as ankle replacement or flat foot reconstruction usually require 1-3 nights in hospital. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will be shown how to use crutches and given clear instructions about weight-bearing on your operated foot.
You will receive a letter for your GP and details of your next outpatient appointment, usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive after a general anaesthetic or sedation.
⚠️ Important: DVT (deep vein thrombosis) is more common after Achilles injury than after many other foot/ankle operations. Report new calf pain or swelling on the non-injured side, or chest pain/breathlessness, urgently.
Keep the foot elevated above the level of your heart for as much of the day as possible during the first 2 weeks. This significantly reduces swelling and helps healing.
Avoid getting the wound wet until it is fully healed, usually 10-14 days. Use a waterproof cover when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective than taking it only when needed.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, calf pain or swelling (possible DVT), shortness of breath, or a temperature above 38°C.
Strict non-weight-bearing on crutches. Foot held with toes pointing down to take tension off the repair.
Boot with multiple heel wedges. Wedges removed gradually to bring the foot back towards neutral. Progressive weight-bearing.
Boot removed. Calf stretching and progressive strengthening under physiotherapy guidance.
Walking comfortably. Light jogging may begin.
Full return to running and sport, with calf strength typically reaching 90-95% of the other side.
Modern functional rehabilitation has narrowed the difference. Surgery has a slightly lower re-rupture rate but a small risk of wound complications. Non-surgical treatment in a boot avoids surgery but rehabilitation must be diligent.
Most patients regain 90-95% of calf strength compared to the unaffected side. A small loss of explosive push-off is common.
For right-sided rupture, typically 10-12 weeks once out of the boot. Left side in an automatic, around 6-8 weeks.
Yes. Return to running is gradual from around 4-6 months, with full sporting return at 6-12 months.
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
The torn ends of the Achilles tendon are rejoined, either through an open incision or a smaller minimally invasive approach. It is usually a day case.
The leg is then protected in a boot while the repair heals.
The main reason is to lower the risk of re-rupture, to under one percent compared with around six percent without surgery. Overall function is similar between the two.
This is balanced against surgical risks such as wound healing problems and nerve irritation.
Often a general or spinal anaesthetic, frequently combined with a nerve block that keeps the area numb for pain relief afterwards.
Your anaesthetist will discuss the best option for you.
Expect a boot for roughly eight to ten weeks with staged changes in foot position, then a structured rehabilitation programme.
Return to sport is often around six to twelve months.
Arrange help at home, get the hang of crutches, and plan time off work, which is longer for jobs on your feet.
Set up a comfortable spot where you can keep the leg elevated.
Calf pain, swelling or redness, or breathlessness, can signal a clot. Spreading wound redness, discharge or a temperature can signal infection.
Follow your team’s clot-prevention advice while the leg is immobilised.