Achilles repair or reconstruction at Cambridge Hospital

What conditions does the surgery treat? 

Surgery is used to treat a ruptured Achilles tendon. Ruptures commonly happen during physical activity, particularly when the foot is forced sharply downward during jumping, when catching a stumble, or when falling from a height. 

It is important to know that most Achilles tendon ruptures do not require surgery. According to Milton Keynes University Hospital NHS Foundation Trust, the majority are treated successfully with a functional brace and physiotherapy, with evidence suggesting similar outcomes to surgery without the associated risks. Surgery tends to be considered for: 

• Cases where there has been a delay in getting treatment 
• Larger or more complex ruptures 
• Competitive or high-level athletes, where minimising any chance of re-rupture is a priority 

The decision to have surgery is reached through a discussion between you and your surgeon based on your injury, lifestyle, and activity goals. 

What are the benefits? 

The goal of treatment, whether surgical or not, is for the tendon ends to heal fully and for you to recover strength in the leg without lasting weakness that would affect walking or sport. 

With surgery and a structured rehabilitation programme, most people can return to running at around six months and to full sporting activity by nine months. Removing the small risk of the tendon rupturing again is one reason surgery is often chosen for competitive athletes. 

Types of repair and reconstruction 

Open repair

uses a cut of approximately 3 to 5 centimetres at the back of the ankle. The surgeon locates both ends of the torn tendon, cleans them, and stitches them back together. This is the standard approach for most surgical cases. 

Minimally invasive repair (also called percutaneous repair)

This uses smaller incisions through the skin, avoiding a single larger cut. This approach may be more appropriate for recreational athletes or for patients where reducing visible scarring is a priority. 

Reconstruction

is used in a smaller number of cases where the torn ends are too far apart to join directly. A nearby tendon called the flexor hallucis longus is used to bridge the gap. Taking this tendon does not significantly affect the function of the foot. 

There is ongoing discussion in the clinical literature about which surgical approach carries the lower risk of re-rupture. Open repair is often recommended for high-level athletes where any chance of re-rupture must be minimised. Your surgeon will advise which option is most appropriate for your injury and goals. 

Before your operation 

Your surgeon will discuss your anaesthetic options before the procedure. Achilles tendon repair can be performed under a general anaesthetic (medicine to put you fully to sleep) or under a spinal or regional anaesthetic (medicine that numbs just the lower part of your body). 

Where possible, surgery is ideally performed within one week of the injury, as operating before significant swelling develops helps the team work more effectively. 

Steps you can take to prepare and support your recovery: 

• Stop smoking before surgery. The skin at the back of the ankle has a limited blood supply, and smoking significantly increases the risk of poor wound healing after this operation. 
• Take vitamin C supplements for six weeks before and six weeks after surgery. Milton Keynes University Hospital advises this can be beneficial; they are available without a prescription from pharmacies and supermarkets. 
• Maintain a healthy diet and keep as active as possible before the operation. 

Tell your surgical team about all the medications you take, including over-the-counter medicines and supplements, so they can advise what to continue or stop before surgery. 

What happens during the procedure? 

Once your anaesthetic has taken effect, your surgical team will: 

1. Make a cut (incision) of approximately 3 to 5 centimetres at the back of your ankle, at the site of the rupture 
2. Locate both ends of the torn tendon and clean them up 
3. Stitch (suture) the two ends firmly back together 
4. If the ends cannot be brought close enough to join, use a nearby tendon from the foot to bridge the gap instead 
5. Inject local anaesthetic around the wound to provide pain relief for the first few hours after waking up 
6. Close the wound with stitches 
7. Place your leg in a plaster cast with your foot pointing slightly downward, to protect the repair while it begins to heal.

Recovery from Achilles tendon repair 

In hospital 

Most people go home on the same day as their operation. An overnight stay may be needed if you have other significant health conditions. 

Before you leave, a physiotherapist will check that you can safely get around using crutches. 

At home 

The full rehabilitation period for an Achilles tendon rupture is approximately six to nine months. The milestones below are a general guide; your surgical team and physiotherapist will give you personalised targets. 

• Weeks 1 to 2: Do not put any weight through the operated leg. Keep it raised (elevated) as much as possible to reduce swelling and support healing. Keep the plaster cast completely dry by using a waterproof cover when bathing or showering. 
• 2 weeks: You will attend a clinic appointment. The wound will be checked and stitches removed. You will be transferred into a surgical walking boot fitted with three wedges. From this point you can begin putting weight through the leg again, which encourages the tendon to heal. The boot should be worn continuously, including at night. 
• Weeks 2 to 10: One wedge is removed from the boot every two weeks, gradually returning your foot to a flat (neutral) position. Some people use a series of plaster casts rather than a boot; your surgeon will advise which suits your situation. 
• 10 weeks: A further clinic review to confirm the tendon has healed. If recovery is on track, you can move into your own supportive footwear and will be referred to a specialist physiotherapist to guide the remainder of your rehabilitation. 

Returning to normal activities: 

• Sedentary (desk-based) work: around 2 weeks after surgery, provided you can keep your foot raised.
• Physical or manual work: longer off work; discuss the timing with your surgeon.
• Driving: when you can walk comfortably in your own footwear and are confident you can make an emergency stop without pain or hesitation. If surgery was on your left leg and you drive an automatic car, you may be able to drive sooner, but only when you are certain it is safe.
• Running: around six months after surgery.
• Full sporting activities: around nine months after surgery.

If you are planning to fly after surgery, speak to your surgeon first. Flying increases the risk of a blood clot in the leg (deep vein thrombosis or DVT), and airlines also have their own rules about flying after recent surgery. 

Risks and complications 

Your surgeon will explain the specific risks of your procedure before you consent to surgery. Known risks include: 

• Blood clots: There is an increased risk of a clot forming in the operated leg. This risk exists whether or not surgery is performed. You may be prescribed blood-thinning medication to reduce it. 
• Nerve injury: There is a small risk of irritating or stretching surrounding nerves during the operation, causing numbness or weakness. These effects usually improve over time but can occasionally persist. 
• Infection: The risk of infection after this type of surgery is up to 5%. Most infections are minor and treated with antibiotics, but occasionally a deeper infection requires a further operation. 
• Delayed wound healing: The skin at the back of the ankle has a limited blood supply, which can slow healing. Smokers are at significantly higher risk of this complication. In rare cases, further surgery involving a plastic surgeon may be needed. 
• Re-rupture: There is a small chance that the repair breaks down and the tendon tears again. Following your post-operative instructions carefully and working consistently with your physiotherapy team helps reduce this risk. 
• Chronic regional pain syndrome (CRPS): A very small number of people develop this condition after foot and ankle surgery. It causes persistent pain, swelling, and sensitivity in the foot. If this develops, input from a specialist pain consultant may be needed. 

Frequently asked questions 

Do I definitely need surgery for an Achilles tendon rupture?

No. The majority of Achilles tendon ruptures are managed successfully without surgery, using a functional brace and physiotherapy. Surgery is most often recommended for competitive athletes, large or complex ruptures, or cases where there has been a delay in starting treatment. Your surgeon will advise which approach is right for your injury and activity level.

How long does recovery take?

The full rehabilitation period is approximately six to nine months. Walking normally is usually possible well before that, but returning to running and sport requires a structured programme and patience.

When can I return to sport?

Most people can start running at around six months after surgery, with a return to full sporting activities targeted at nine months. How quickly this happens varies between individuals and depends on the sport, the type of repair performed, and the quality of the rehabilitation programme.

When can I go back to work?

If your job is desk-based and you can keep your foot elevated, you may be able to return around two weeks after surgery. Physical or manual work will require a longer period off. Your surgeon will advise based on your specific role.

When can I drive again?

You can return to driving when you can walk comfortably in your own footwear and are confident you can perform an emergency stop without pain or hesitation. If the surgery was on your left leg and you drive an automatic car, this may be possible sooner, but only when it is safe to do so.

Is it safe to fly after Achilles surgery?

Flying after recent surgery increases the risk of a blood clot in the leg (DVT). Speak to your surgeon before booking any flights for individual guidance on timing, and check your airline's own regulations about flying after a surgical procedure.