• Foot Conditions

  • Ankle and Achilles Conditions

  • Sports Injuries

  • Keyhole Surgery

Achilles Tendon Rupture

What is it?

The Achilles tendon is the largest and strongest tendon in the body. It is located behind the ankle and connects the calf muscles to heel bone. It is used when you walk, run and jump.

What are the Symptoms of an Achilles Tendon Rupture?

If the Achilles tendon is ruptured you may experience a sudden pain in the back of your leg, as if someone had kicked you, followed by, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound may be heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone. Ruptures usually occurs in those aged 30 – 70 years, during a sudden forceful push off from the foot. Without proper healing of the tendon, you will have a permanent limp and weakness when using the leg.

How is it Treated?

Debate remains regarding the best form of treatment for a ruptured Achilles tendon. The 2 options are:immobilisation or operation. A recent meta-analysis of scientific studies showed that compared to immobilisation, an operation reduces the risk of re-rupture and allows a quicker return to work. An operation is not without risk and these must be balanced against the benefit of a lower re-rupture rate. Both treatments involve immobilisation for 8 weeks.

Immobilisation (no operation)

Mr Gordon utilises the best scientific evidence available for management in patients choosing not to have surgery. See Treatment Options Summary table below for an outline of management.

The Operation

This is a day case procedure performed under general anaesthetic and a popliteal anaesthetic block. An incision is made near the tendon and the ends are carefully sutured together. Mr Gordon uses the latest suture technology, coupled with a scientifically proven stitching technique, which creates a very strong fixation, allowing accelerated rehabilitation by early weight bearing and physiotherapy starting at 2 weeks.

Achilles Tendon Rupture – Surgical Repair Video

Achilles Tendon Rupture - Surgical Repair

What are the Complications of an Operation?

The actual risk of a complication is individual to you and will depend on a number of factors. Mr Gordon will discuss these with you. Risks a very low for fit and healthy, non smokers, but increase with age, smoking, diabetes and other chronic diseases. Complications include: Infection,wound healing difficulties, nerve injury, deep vein thrombosis, adhesions and permanent loss of push off power.

How Long is the Overall Recovery?

It will take a good 3-4 months before you are walking without thinking about the injury. Remember, you will be immobilised for 2 months for treatment. One normally returns to full sport at 6-9 months. The calf muscle bulk takes about 1 year to return to normal and the tendon will be thicker for many years.

Post Operation Accelerated Rehabilitation Protocol

Please see the ‘Achilles Tendon Repair: Post Operative Accelerated Rehabilitation Protocol’


Treatment Options Summary


Non Operative


4 weeks in plaster touch weight bearing with crutches (less than 10% body weight) 2 weeks in plaster touch weight bearing with crutches (less than 10% body weight)
4 weeks in walking boot full weight bearing 6 weeks in walking boot full weight bearing
Lower complication rate Higher complication rate
Higher re-rupture rate Lower re-rupture rate
Slower return to activities Faster return to activities


What Should I Do?

This will depend on your discussion with Mr Gordon. In general,if you are active (and want to return to those activities), fit and healthy and a non smoker, an operation is advised, if you are a smoker, diabetic or have other medical problems, non operative management is advised.

lmmobilisation (no operation) Rehabilitation Protocol


Weeks Immobilisation Method
1 POP 10% body weight bearing
2 POP 10% body weight bearing
3 VACOped boot locked at 30° plantarflexion
100% body weight bearing
4 VACOped boot locked at 30° plantarflexion
100% body weight bearing
5 VACOped boot 30-15° range of motion
100% body weight bearing
6 VACOped boot 30-15° range of motion
100% body weight bearing
7 VACOped boot 30-0° range of motion
100% body weight bearing
8 VACOped boot 30-0° range of motion
100% body weight bearing
9 Unlocked
100% body weight bearing
10 Unlocked
100% body weight bearing


Vacoped Boot Rehabilitation Protocol Post Surgical Repair of Achilles Tendon

The boot will be set by Mr Gordon following the operation, while you are asleep.
Please read the instructions on how to adjust the boot
At week 3 and for all subsequent weeks, only adjust the lower ‘screw’ using the key provided, this will allow more ankle movement in a gradual and controlled manner.
One notch on the boot equals 5 degrees.

Follow the protocol below:

Week Vacoped Range of Motion to be Set (full weight bearing throughout)
1 30 degrees only (tip toe position only )
2 30 degrees only (tip toe position only )
3 30-25 degrees (very slight ankle movements)
4 30-20 degrees (very slight ankle movements)
5 30-15 degrees (increasing ankle movements)
6 30-10 degrees (increasing ankle movements)
7 30-5 degrees (more ankle movements). Change to flat sole
8 30-0 degrees (more ankle movements). Keep flat sole


Airselect Standard Heel Wedges

Even Up device to equalise leg lengths while wearing Vacoped boot

Aircast AirSelect

Reference List

Wallace RG, Heyes GJ, Michael AL The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture.J Bone Joint Surg Br 2011;93:1362-6.

Cetti, R., L. 0. Henriksen, and K. S. Jacobsen. “A new treatment of ruptured Achilles tendons. A prospective randomized study.” Clin.Orthop.Relat Res.308 (1994): 155-65.

Costa,M. L., et al. “Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study.” Injury 34.11 (2003): 874-76.

Kangas, J., et al. “Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective,randomized,clinical study.” J.Trauma 54.6 (2003}: 1171-80.

Maffulli,N., et al. “Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendonrch this journal.” Am.J.Sports Med. 31.5 (2003): 692-700.

Mortensen, H. M., 0. Skov, and P. E. Jensen. “Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective,randomized clinical and radiographic study.” J.Bone Joint Surg.Am. 81.7 (1999}: 983-90.

Suchak, A. A., et al. “Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis.” Clin.Orthop.Relat Res. 445 (2006): 216-21