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Achilles Tendon Rupture: Should I Have Surgery


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Decision Point

Achilles Tendon Rupture: Should I Have Surgery?

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?

Get the facts

Your 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 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 your rehabilitation program after the surgery.
  • 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. An Achilles tendon rupture must be treated.

How well do treatments work?

Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon and 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.

After either surgery or immobilization, more than 80 out of 100 people are able to return to all the activities they did before the injury, including returning to sports.1

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. 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.

A review of small studies of surgeries done within 3 weeks of an Achilles tendon rupture showed:1

  • Among people who have open surgery, 5 out of 100 may have another rupture after surgery. These small studies suggest that the risk of rerupture is about the same with percutaneous surgery.
  • About 18 out of 100 people who had open surgery had an infection, and there were no infections after percutaneous surgery. Infection is possible with any surgery, but it is more common with open surgery.
  • 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 problems with scarring, pain, delayed wound healing, and nerve damage.

What are the risks of immobilization?

With immobilization, the greatest risk is that the tendon will rupture again. Among people who have immobilization, about 12 out of 100 will have another rupture.1

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.

Why might your doctor recommend surgery for a ruptured Achilles tendon?

Your doctor may advise surgery if:

  • You are physically active in sports, at work, or at home.
  • You have a job that requires leg strength.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









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.
  • 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.
  • All surgery has risks, including bleeding and infection. Your age and your health can also increase your risk.
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.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal 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.

Carlo, age 34

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.

Marian, age 55

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.

Brandi, age 45

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 stretching. I won't be one of those guys who reruptures after using a cast!

Fred, age 33

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.

Having surgery

Immobilization

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

If I get a cast or brace, I am more likely to have another rupture than if I have surgery.

  • TrueYou're right. You are more likely to have another rupture after immobilization treatment than after surgery.
  • FalseSorry, that's not right. You are more likely to have another rupture after immobilization treatment than after surgery.
  • I'm not sureIt might help to go back and read "Get the Facts." You are more likely to have another rupture after immobilization treatment than after surgery.
2.

Either treatment will help heal my tendon, but immobilization has fewer risks.

  • TrueYou are right. Both treatments are usually successful, but immobilization has fewer risks.
  • FalseSorry, that's not right. Both treatments are usually successful, but immobilization has fewer risks.
  • I'm not sureIt may help to go back and read "Get the Facts." Both treatments are usually successful, but immobilization has fewer risks.
3.

I am physically active at work and at home, so immobilization may be the best choice for me.

  • TrueSorry, that's not right. If you are physically active in sports, at work, or at home, surgery is often advised.
  • FalseYou are right. If you are physically active in sports, at work, or at home, surgery is often advised.
  • I'm not sureIt may help to go back and read "Get the Facts." If you are physically active in sports, at work, or at home, surgery is often advised.

Decide what's next

1.

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?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

Credits and References

Credits
CreditsHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerDavid Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine

References
Citations
  1. Khan RJ, et al. (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.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your 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 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 your rehabilitation program after the surgery.
  • 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. An Achilles tendon rupture must be treated.

How well do treatments work?

Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon and 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.

After either surgery or immobilization, more than 80 out of 100 people are able to return to all the activities they did before the injury, including returning to sports.1

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. 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.

A review of small studies of surgeries done within 3 weeks of an Achilles tendon rupture showed:1

  • Among people who have open surgery, 5 out of 100 may have another rupture after surgery. These small studies suggest that the risk of rerupture is about the same with percutaneous surgery.
  • About 18 out of 100 people who had open surgery had an infection, and there were no infections after percutaneous surgery. Infection is possible with any surgery, but it is more common with open surgery.
  • 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 problems with scarring, pain, delayed wound healing, and nerve damage.

What are the risks of immobilization?

With immobilization, the greatest risk is that the tendon will rupture again. Among people who have immobilization, about 12 out of 100 will have another rupture.1

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.

Why might your doctor recommend surgery for a ruptured Achilles tendon?

Your doctor may advise 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?
  • 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.
  • All surgery has risks, including bleeding and infection. Your age and your health can also increase your risk.
  • 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 stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal 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."

— Carlo, age 34

"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."

— Marian, age 55

"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."

— Brandi, age 45

"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 stretching. I won't be one of those guys who reruptures after using a cast!"

— Fred, age 33

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.

Having surgery

Immobilization

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. If I get a cast or brace, I am more likely to have another rupture than if I have surgery.

  • True
  • False
  • I'm not sure
You're right. You are more likely to have another rupture after immobilization treatment than after surgery.

2. Either treatment will help heal my tendon, but immobilization has fewer risks.

  • True
  • False
  • I'm not sure
You are right. Both treatments are usually successful, but immobilization has fewer risks.

3. I am physically active at work and at home, so immobilization may be the best choice for me.

  • True
  • False
  • I'm not sure
You are right. If you are physically active in sports, at work, or at home, surgery is often advised.

Decide what's next

1. 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?

Certainty

1. 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.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerDavid Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine

References
Citations
  1. Khan RJ, et al. (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.

Last Revised: January 4, 2011

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & David Bardana, MD, FRCSC - Orthopedic Surgery, Sports Medicine


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