Achilles Tendon Rupture: Should I Have Surgery?
Achilles Tendon Rupture: Should I Have Surgery?Skip to the navigationYou 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. Achilles Tendon Rupture: Should I Have Surgery?Get the factsYour options- Have surgery for a ruptured Achilles tendon.
- Treat
the rupture with a cast or brace (immobilization).
Key points to remember- You can treat an Achilles tendon rupture with
surgery or by using a cast, splint, brace, walking
boot, or other device that will keep your lower leg and ankle from moving (immobilization).
- Both surgery and immobilization are usually successful. Another
rupture is less likely after surgery than after immobilization. But
immobilization has fewer other risks.
- The success of your surgery depends
on many things, including how badly your tendon is damaged, how soon after your
rupture you have surgery, and how soon you start and how well you follow a rehabilitation program.
- If you are younger or are physically active in sports, at
work, or at home, surgery is often advised. If you are older or are inactive,
immobilization is often advised.
FAQs 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: - Your surgeon's experience.
- The
type of surgery you have (percutaneous or open surgery).
- How badly
your tendon is damaged.
- How soon after the rupture your surgery is
done.
- How soon your
rehabilitation (rehab) program starts after
surgery.
- How well you follow your rehab program.
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 for Achilles tendon rupture*| 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) Effects on pain and activityWhen 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.) - Out of 100 people who have surgery, 73 of them will not have any problems 1 year later. This means that 27 out of 100 will still have problems.
- Out of 100 people who don't have surgery, 51 of them will not have any problems 1 year later. This means that 49 out of 100 will still have problems.
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.) - Out of 100 people who have surgery, 69 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 31 out of 100 will not.
- Out of 100 people who don't have surgery, 68 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 32 out of 100 will not.
Risk of tendon rupturing againNo 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. - With surgery, 5 out of 100 will rupture the tendon again within 1 to 2 years. This means that 95 out of 100 will not.
- Without surgery, 12 out of 100 will rupture the tendon again with 1 to 2 years. This means that 88 out of 100 will not.
Infection after surgeryAchilles 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. Understanding the evidenceSome 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: - You are physically active in sports, at work,
or at home.
- You have a job that requires leg strength.
Compare your options | |
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What is usually involved? |
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What are the benefits? |
| |
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What are the risks and side effects? |
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Have surgery for
Achilles tendon rupture Have surgery for
Achilles tendon rupture - You will most likely go home the
same day as surgery.
- You will spend 6 to 12 weeks after surgery
wearing a walking cast or boot.
- If you sit at work, you can go back in 1 to 2 weeks. If you're on
your feet at work, you may need 6 to 8 weeks before you can go back.
- Your total recovery time can be up to 6 months.
- Surgery repairs the tendon and
makes another rupture less likely.
- You can go back to work and
resume daily activities sooner than with immobilization.
- All surgery has risks, including bleeding and infection. Your age
and your health can also increase your risk.
- You may have:
- Minor pain and temporary nerve
damage.
- Slight risk of deep vein thrombosis or permanent nerve
damage.
- A small risk of repeat tendon rupture.
Treat the rupture with a
cast or brace (immobilization) Treat the rupture with a
cast or brace (immobilization) - You'll wear a cast, splint,
brace, walking boot, or other device for several months.
- Your total recovery time can be up to 6 months.
- Immobilization allows you to
avoid surgery and the risk of wound infection.
- You may have:
- Repeat tendon rupture.
- Loss of
strength in the leg.
- Minor pain and temporary nerve damage.
- A very
slight risk of deep vein thrombosis or permanent nerve damage.
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. 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. 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.
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! What matters most to you?
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. More important Equally important More important My job requires that I have strong legs. My job doesn't require that I have strong legs. More important Equally important More important I'm not worried about the risks of surgery. I'm worried about the risks of surgery. More important Equally important More important 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. More important Equally important More important I want to return to my normal activity levels as soon as possible. The long recovery time does not bother me. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important Where are you leaning now?
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) Leaning toward Undecided Leaning toward What else do you need to make your decision?1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure Your SummaryHere's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Next stepsWhich way you're leaningHow sure you areYour commentsKey concepts that you understoodKey concepts that may need reviewCredits | Author | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine |
|---|
References Citations - American Academy of Orthopaedic Surgeons (2009). Diagnosis and Treatment of Acute Achilles Tendon Rupture: Guideline and Evidence Report. Available online: http://www.aaos.org/research/guidelines/atrguideline.asp.
- Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Other Works Consulted - Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
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. Achilles Tendon Rupture: Should I Have Surgery?Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. - Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the FactsYour options- Have surgery for a ruptured Achilles tendon.
- Treat
the rupture with a cast or brace (immobilization).
Key points to remember- You can treat an Achilles tendon rupture with
surgery or by using a cast, splint, brace, walking
boot, or other device that will keep your lower leg and ankle from moving (immobilization).
- Both surgery and immobilization are usually successful. Another
rupture is less likely after surgery than after immobilization. But
immobilization has fewer other risks.
- The success of your surgery depends
on many things, including how badly your tendon is damaged, how soon after your
rupture you have surgery, and how soon you start and how well you follow a rehabilitation program.
- If you are younger or are physically active in sports, at
work, or at home, surgery is often advised. If you are older or are inactive,
immobilization is often advised.
FAQs What is the Achilles tendon, and what is an Achilles tendon rupture?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. How well do treatments work?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: - Your surgeon's experience.
- The
type of surgery you have (percutaneous or open surgery).
- How badly
your tendon is damaged.
- How soon after the rupture your surgery is
done.
- How soon your
rehabilitation (rehab) program starts after
surgery.
- How well you follow your rehab program.
What are the risks of surgery?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. What are the risks of immobilization?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. What do numbers tell us about treatment for a ruptured Achilles tendon?Results of treatment for Achilles tendon rupture*| 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) Effects on pain and activityWhen 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.) - Out of 100 people who have surgery, 73 of them will not have any problems 1 year later. This means that 27 out of 100 will still have problems.
- Out of 100 people who don't have surgery, 51 of them will not have any problems 1 year later. This means that 49 out of 100 will still have problems.
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.) - Out of 100 people who have surgery, 69 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 31 out of 100 will not.
- Out of 100 people who don't have surgery, 68 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 32 out of 100 will not.
Risk of tendon rupturing againNo 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 . - With surgery, 5 out of 100 will rupture the tendon again within 1 to 2 years. This means that 95 out of 100 will not.
- Without surgery, 12 out of 100 will rupture the tendon again with 1 to 2 years. This means that 88 out of 100 will not.
Infection after surgeryAchilles 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. Understanding the evidenceSome 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.
Why might your doctor recommend surgery for a ruptured Achilles tendon?Your doctor may advise you to have surgery if: - You are physically active in sports, at work,
or at home.
- You have a job that requires leg strength.
2. Compare your options| | Have surgery for
Achilles tendon rupture | Treat the rupture with a
cast or brace (immobilization) |
|---|
| What is usually involved? | - You will most likely go home the
same day as surgery.
- You will spend 6 to 12 weeks after surgery
wearing a walking cast or boot.
- If you sit at work, you can go back in 1 to 2 weeks. If you're on
your feet at work, you may need 6 to 8 weeks before you can go back.
- Your total recovery time can be up to 6 months.
| - You'll wear a cast, splint,
brace, walking boot, or other device for several months.
- Your total recovery time can be up to 6 months.
|
|---|
| What are the benefits? | - Surgery repairs the tendon and
makes another rupture less likely.
- You can go back to work and
resume daily activities sooner than with immobilization.
| - Immobilization allows you to
avoid surgery and the risk of wound infection.
|
|---|
| What are the risks and side effects? | - All surgery has risks, including bleeding and infection. Your age
and your health can also increase your risk.
- You may have:
- Minor pain and temporary nerve
damage.
- Slight risk of deep vein thrombosis or permanent nerve
damage.
- A small risk of repeat tendon rupture.
| - You may have:
- Repeat tendon rupture.
- Loss of
strength in the leg.
- Minor pain and temporary nerve damage.
- A very
slight risk of deep vein thrombosis or permanent nerve damage.
|
|---|
Personal storiesPersonal stories about surgery for Achilles tendon rupture
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." "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." "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." "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!" 3. What matters most to you?
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. More important Equally important More important My job requires that I have strong legs. My job doesn't require that I have strong legs. More important Equally important More important I'm not worried about the risks of surgery. I'm worried about the risks of surgery. More important Equally important More important 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. More important Equally important More important I want to return to my normal activity levels as soon as possible. The long recovery time does not bother me. More important Equally important More important My other important reasons: My other important reasons: More important Equally important More important 4. Where are you leaning now?
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) Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?
Check the facts
1.
I am less likely to rupture the tendon again if I have surgery than if I use a cast or brace. You're right. You are less likely to have another rupture after surgery than after treatment with a cast or brace. 2.
Surgery has some risks that immobilization does not. You are right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as a deep wound infection. 3.
My job requires a lot of walking. Immobilization gives me the best chance of getting back to that without problems. You are right. People who have surgery are less likely to have problems with walking than people who use immobilization. Decide what's next1.
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? Certainty1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure 2.
Check what you need to do before you make this decision. Credits | By | Healthwise Staff |
|---|
| Primary Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine |
|---|
References Citations - American Academy of Orthopaedic Surgeons (2009). Diagnosis and Treatment of Acute Achilles Tendon Rupture: Guideline and Evidence Report. Available online: http://www.aaos.org/research/guidelines/atrguideline.asp.
- Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Other Works Consulted - Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Current as of:
March 21, 2017 American Academy of Orthopaedic Surgeons (2009). Diagnosis and Treatment of Acute Achilles Tendon Rupture: Guideline and Evidence Report. Available online: http://www.aaos.org/research/guidelines/atrguideline.asp. Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9). Last modified on: 8 September 2017
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