When Does an Achilles Tendon Tear Need Surgery?

An Achilles tendon tear may need surgery when the tendon is completely ruptured, significantly retracted, or unlikely to heal properly. Surgery is also considered for active people, athletes, or patients who need to regain strong push-off strength and reduce the risk of reinjury.

At Total Orthopedics and Sports Medicine, Dr. Richard McCormack, a board-certified orthopedic surgeon, evaluates the severity, location, and extent of the Achilles tendon injury through a physical examination. After that, he performs Achilles tendon repair surgery using modern surgical methods designed to restore tendon strength and function. Call us at 855-321-6784 for expert diagnosis and surgical treatment.

When Should an Achilles Tendon Tear Be Treated With Surgery?

Surgery is commonly recommended for a complete Achilles tendon rupture, especially in younger, active patients, athletes, or those who need to return quickly to demanding activities. It may also be considered when the tendon ends are significantly separated, weakness persists, or nonsurgical treatment carries a higher risk of re-rupture.

In fact, PubMed studies suggest that tendon rerupture was more common after nonoperative treatment (6.2%) than after open or minimally invasive surgery (0.6% each). Another PMC research found that the rate of rerupture was 20.8% after non-surgical and 1.7% after surgical treatment. Therefore, before performing surgery, doctors evaluate the following factors that may impact surgical outcomes:

Severity of Tendon Tear

A complete Achilles tendon rupture, in which the tendon is fully separated, may benefit more from surgical repair than a small partial tear. Doctors also assess the amount of tendon separation, tissue quality, and whether the tendon ends can be brought together without causing extreme stress.

Location of the Tendon Injury

A rupture that occurs in the middle portion of the tendon may be repaired differently from an injury near the heel bone. However, injuries near the tendon-bone attachment may require specialized techniques to securely restore the tendon and its attachment to the heel.

Activity Level

Athletes and people who run, jump, or perform physically demanding work place greater demands on the Achilles tendon during activities such as sprinting, jumping, and climbing stairs. Because these activities require strong push-off power, surgery may be considered when restoring tendon strength and function. In addition, people with physically demanding jobs may opt for surgical repair of Achilles tears.

Overall Health

Before surgery, doctors evaluate your general health to determine whether you can safely undergo the procedure and recover effectively. Conditions that affect circulation, wound healing, blood sugar control, or immune function may increase surgical risks. Blood thinner medications, smoking status, previous surgeries, and other health considerations may also be reviewed before you are taken to the operating room.

Tendon Gap and Tissue Quality

Doctors may use imaging and physical examination to assess the extent of separation between the torn tendon ends and whether the remaining tendon tissue appears healthy. A larger gap or poor-quality tissue can make direct repair more challenging and may require a different surgical technique. In some cases, additional procedures may be needed to restore adequate tendon continuity.

Timing of Treatment

An acute Achilles tendon rupture is generally easier to repair because the tendon ends have not had extensive time to retract, scar, or develop adhesions. However, delayed treatment can sometimes make direct repair more difficult. It also requires a more complex reconstruction depending on the condition of the tendon.

Can a Ruptured Achilles Tendon Heal With Non-Surgical Treatments?

Yes, a ruptured Achilles tendon can heal with non-surgical treatment, which typically involves immobilization or functional bracing, followed by early, guided rehabilitation. However, initial immobilization after the surgery may last for 2 to 6 weeks. As a result, healing may take several months, and some patients may experience reduced strength or a higher risk of re-rupture.

Moreover, regenerative treatments such as PRP may improve healing in Achilles injuries. But these non-surgical treatments are considered only when the tendon ends can heal in an appropriate position, and the patient has lower physical demands or medical factors that increase surgical risk. In such cases, proper treatment usually progresses from protecting the tendon to gradually restoring ankle movement, strength, and function.

How Common Are Ruptured Achilles Tendons?

Ruptured Achilles tendons are very common; a PubMed systematic review involving more than 630 million people and approximately 568,000 ruptures reported a pooled incidence of 15.7 per 100,000 person-years. Another NCBI study reported approximately 8 cases per 100,000 people annually.

The incidence reached 31.1 per 100,000 person-years, while men experienced about three times the incidence of women. Researchers also found that Achilles tendon injuries are common in men aged 30–49 years. Similarly, an NIH study reported that the rate of Achilles tendon rupture increased from 2.1 to 21.5 per 100,000 person-years between 1979 and 2011.

What Causes an Achilles Tendon Rupture?

An Achilles tendon rupture usually occurs when the tendon is suddenly overloaded, especially during running, jumping, or rapid changes in direction. Common causes include sports injuries, sudden acceleration, accidental injury, and forceful pushing off. Age-related tendon degeneration, previous injuries, and certain medications can also increase the risk of rupture.

Besides that, injury often occurs when the calf muscle contracts forcefully while the foot stays raised, placing excessive tension on the longest tendon (Achilles). Similarly, certain medications, particularly corticosteroids and some fluoroquinolone antibiotics, have been associated with increased tendon injury. Here’s how these factors can lead to a torn Achilles tendon:

• Sudden Acceleration: Quickly pushing off to sprint places a powerful load through the calf muscles and Achilles tendon. If the force exceeds what the tendon can tolerate, rupture can occur.
• Falls: A sudden fall, particularly when the foot is forced upward while the calf contracts, can overstretch the tendon and cause it to tear.
• Forceful Push-Off: Pushing off the ground forcefully activates the calf muscles and places tension on the tendon, which can result in rupture.
• Age-Related Tendon Degeneration: As a person ages, the tendons become less flexible and develop degenerative changes. These changes reduce its ability to tolerate high loads.
• Previous Achilles Tendon Injury: A previously injured or weakened tendon may have reduced leg strength, potentially increasing the risk of another rupture.
• Corticosteroid Use: Corticosteroids can weaken tendon tissue by reducing collagen production and impairing tendon repair. This can make the tendon unable to bear normal stress.
• Fluoroquinolone Antibiotics: Fluoroquinolones can adversely affect tendon structure and collagen metabolism, making the Achilles more vulnerable to injury.

In fact, the PMC control study reported that current fluoroquinolone use significantly increased the risk of Achilles tendon rupture. It also found that taking fluoroquinolones with corticosteroids further increased the risk of rupture.

What Are the Symptoms of a Torn Achilles Tendon?

A ruptured tendon often causes sudden, persistent pain near the back of the ankle, sometimes described as a kick or snap. Other common symptoms may include swelling, bruising, difficulty walking, and an inability to rise on the toes. In some cases, your calf may feel weak, especially when pushing off while walking, running, or climbing stairs. You can also hear a ‘popping’ sound during an Achilles rupture. Some people may have tenderness or feel a small space or gap where the tendon has separated.

How Do Doctors Diagnose a Ruptured Achilles Tendon?

Dr. Richard McCormack, our orthopedic specialist, performs a detailed physical examination and reviews medical history to diagnose a ruptured Achilles tendon. He also performs the Thompson test to check whether the tendon is intact. In some cases, he may perform a Matles test, in which he bends the knee to 90 degrees while face down to check whether the injured foot rests differently than the healthy side.

If the diagnosis is unclear or the injury is complex, doctors may use imaging tests such as an ultrasound or an MRI to confirm the tear. Ultrasound can show whether the tendon has a complete or partial tear and help doctors identify the injury’s location and extent. In contrast, MRI provides more detailed images of the tendon and surrounding soft tissues.

It also helps Dr. Richard McCormack assess tendon retraction, associated muscle injury, or other abnormalities. In addition, during the examination, our doctor checks for swelling, bruising, tenderness, and weakness. He may also assess your ability to walk, push off the foot, or stand on your toes. Similarly, he may touch the tendon area to feel for a gap, dip, or lack of normal tissue contour. Schedule an evaluation with our healthcare provider to determine the severity of the injury and get the most appropriate treatment.

Which Surgical Techniques Are Used for Achilles Tendon Repair?

Surgical repair of an Achilles tendon rupture may involve open repair, minimally invasive repair, or percutaneous repair. However, an orthopedic surgeon selects the best technique based on the tear’s location and severity, tissue quality, time since injury, and the patient’s activity level and overall health.

Here’s how a surgeon performs the following Achilles tendon surgeries to repair a torn tendon:

Open Achilles Tendon Repair

Open Achilles tendon repair involves making an incision over the back of the ankle to directly visualize the ruptured tendon. Surgeons carefully identify the torn ends, remove damaged tissue as needed, and reattach the tendon with strong sutures. This technique provides excellent visualization, making it a preferred option for complex or significantly displaced ruptures.

Minimally Invasive Achilles Tendon Repair

Minimally invasive repair uses several smaller incisions rather than one larger incision. In this technique, surgeons use specialized instruments to identify the torn tendon ends while limiting disruption to the surrounding soft tissues. This approach provides reliable tendon fixation while reducing potential complications.

Percutaneous Achilles Repair

Percutaneous repair involves passing sutures through small skin punctures to reconnect the ruptured tendon. Since this technique requires less exposure than traditional open surgery, it can minimize soft-tissue disruption. However, surgeons use careful techniques because limited visualization can make it difficult to protect nearby structures.

Augmented Achilles Tendon Repair

A surgeon may consider augmented repair when poor tendon quality, a large gap, or a chronic rupture prevents simple suture repair. During this surgery, they may reinforce the repair using additional tendon tissue, graft material, or other biological augmentation. This improves structural support and regains strength in the injured leg.

What Are the Risks of Achilles Tendon Repair Surgery?

Achilles tendon repair surgery may carry risks, including active infection, blood vessel or nerve damage, blood clots, and tendon re-rupture. In fact, PMC research found that open Achilles tendon repair carries approximately a 2% to 4% risk of deep infection. Some patients may also experience persistent pain, stiffness, weakness, or reduced ankle movement during recovery.

Additionally, limited blood supply can cause healing problems and increase the risk of complications. The repaired tendon can also tear again if you place excessive stress on it before it heals adequately. However, you should get immediate medical attention if you develop noticeable scar tissue around the incision or tendon within a few weeks after surgery.

How Long Does a Torn Achilles Tendon Take to Heal?

A torn or ruptured Achilles tendon takes 4 to 6 months to heal for basic everyday activities. But a full recovery and return to high-intensity sports or heavy physical work generally requires 6 to 12 months. This recovery time may vary depending on the severity of the tear, treatment approach, overall health, and rehabilitation progress.

Many patients can also walk again within 3 months post-surgery. During the first 6–8 weeks, you must wear a walking cast, splint, or specialized boot to keep the torn tendon ends together. After 12 weeks, you can transition to full weight-bearing inside a walking boot. Moreover, after 3 to 6 months, you can walk in regular shoes and continue playing sports as the injured area regains strength. At this stage, you must focus on rebuilding calf muscle size and tendon strength.

What Are the Signs of Tendon Rupture Healing?

Signs of tendon rupture healing include reduced swelling, improved movement, increased strength, and better ability to bear weight or use the affected area. As healing progresses, function gradually improves, although stiffness, weakness, and tenderness may persist during the early stages of recovery.

Moreover, walking, pushing off, lifting, and other daily activities become easier as tendon function improves. You may also notice dark marks on the skin turn light or disappear. Similarly, the gap or dip in the tendon feels less deep as new tissue forms.

How Do You Prevent an Achilles Tendon Rupture?

You can reduce the risk of an Achilles rupture by gradually increasing exercise intensity and warming up before physical activity. You can also reduce the risk of rupture by strengthening the calf muscles, maintaining flexibility, and wearing supportive footwear.

Similarly, avoid sudden increases in running or jumping, and address Achilles pain early before it becomes a more serious injury. In addition, stretching the calves and ankles may help maintain adequate flexibility. Using proper technique during sports can also reduce excessive stress on the Achilles tendon.

Get Expert Treatment for an Achilles Tendon Tear from Dr. Richard McCormack in East Meadow

Delaying treatment for an Achilles tendon tear can create significant challenges for your recovery. As the injury remains untreated, you may experience persistent pain, swelling, reduced ankle strength, and difficulty walking. In some cases, the torn tendon may retract and form scar tissue, which can complicate repair and recovery.

At Total Orthopedics and Sports Medicine, Dr. Richard McCormack, Associate Chairman of Orthopedics, uses precise tendon approximation and minimally invasive surgical techniques to restore tendon strength. He also prioritizes careful incision planning or secure fixation and provides a progressive recovery plan aligned with your functional goals. Visit at 2339 Hempstead Turnpike, East Meadow, NY 11554, or contact us at 855-321-6784 to schedule your tendon evaluation.

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