A doctor might recommend surgery if you experience significant injury to your Achilles tendon. But experts differ on which technique is best. Regardless of technique, recovery usually takes 3–6 months.

Your Achilles tendon is the strongest tendon in your body. It helps transmit force from your calf to your foot. Despite its strength, the Achilles tendon is the most frequently ruptured tendon in the leg.

Some studies have reported Achilles tendon tears at rates of about 18 per 100,000 people. Achilles injuries are particularly common among people in their 20s–40s and especially in those who participate in sports.

Doctors sometimes recommend surgery for treating Achilles tears. The debate remains about when doctors should perform surgery. In general, doctors recommend surgery for moderate to severe injuries.

Read on to learn more about when your doctor may recommend Achilles surgery and the available surgery options.

Your doctor may recommend Achilles surgery if you tear your Achilles tendon. Tendon tears range from minor to severe.

There’s debate over when surgery is the best treatment option, but many doctors recommend surgery for tears larger than 50% of the cross-sectional area of your tendon. They sometimes recommend surgery for some smaller tears if you have greatly reduced movement.

Successful healing rates between conservative treatment with immobilization and surgical repair seem similar. Conservative treatment may link to higher reinjury rates.

Doctors use many types of surgeries to treat Achilles injuries. Achilles surgery can broadly involve one of the following:

  • percutaneous repair
  • open repair
  • mini-open repair

The optimal surgical technique is still under debate.

Percutaneous repair

Percutaneous repair is a widely used minimally invasive option. During the procedure, your surgeon makes multiple punctures through your skin. They then weave a stitch through your tendon with a special tool.

Percutaneous repair reduces the need for a large opening, but an injury to the sural nerve occurs in as many as 6.8% of surgeries.

Open repair

Open repair is often effective but links to higher rates of wound complications that may require a second surgery. Open repair involves repairing your tendon through a large opening.

Your surgeon may use various other techniques during the surgery, including the following:

  • Tendon transfer: A tendon transfer involves moving a working tendon in your foot to reinforce your Achilles.
  • Tendon graft: A graft is when they rebuild the tendon with tissue from your body, a donor, or with a synthetic material.
  • Gastrocnemius recession: The surgeon loosens your calf muscle fibers through a separate incision to reduce tension in your Achilles tendon.
  • Achilles debridement: The surgeon removes the injured tissue from your tendon.

Mini-open technique

The mini-open technique is a minimally invasive option that may reduce complications such as infections and sural nerve injury.

Your surgeon makes a small incision over your tendon, about 1.5 inches long, and spreads apart the tissue underneath. They then use special tools to help stitch your tendon together.

Mini-open repair may help reduce the risk of infection, but the overall complication rate isn’t significantly different from other options.

Here’s a general outline of what you can expect during surgery.

  1. You’ll receive a spinal anesthetic to block the pain from your waist down. You’ll also likely receive a sedative to make you sleepy through the surgery.
  2. Your surgeon will make an opening or a series of openings around your ankle.
  3. The surgeon will reconnect the two injured ends of your tendon with stitches. In some cases, your surgeon may remove part of your tendon.
  4. Your surgeon may also need to repair other structures in your ankle if you have other injuries.
  5. The surgeon will close the openings with stitches and cover them with bandages to help prevent infection.
  6. After your procedure, you’ll likely have a splint on your foot to keep you from moving it.

Surgery times can vary, but your procedure may take about 80 minutes.

Potential risks of Achilles surgery include:

Infections are the most serious complication of open repair. Infection and wound problems occur in about 12.5% of people.

Many people go home on the same day as their surgery. During the first 2 weeks, medical staff will likely give you crutches and advise you to elevate your leg as much as possible.

After 2 weeks, they’ll encourage you to start putting weight on your tendon and give you a surgical boot with three wedges to keep your toe pointed down. You’ll likely wear this boot for about 8 weeks. They’ll remove one wedge about every 2 weeks to increase the length of your tendon.

Many people can walk regularly in 12.5–18 weeks and return to some sports activity in 6 months. You might return to full sports activity in 9 months if your tendon heals properly.

Success rates for Achilles tendon surgery are generally higher than 70%.

About 80% of athletes can return to their sports, but it may often take 2–3 years to regain their usual function.

Doctors usually perform surgery 1–2 weeks after your injury to allow swelling to go down.

Before your procedure, you’ll have a presurgical assessment. Your surgeon will give you instructions about when to stop eating and drinking and whether you need to stop taking any medications.

You’ll be unable to drive yourself home after your procedure, so planning a way home in advance is important.

Here are some frequently asked questions people have about Achilles surgery.

How long does it take to recover from Achilles surgery?

In a small 2017 study involving 29 people with surgically treated Achilles tendon ruptures, researchers found that nearly 90% returned to sports activity. They returned after an average of 7.7 months.

Is Achilles surgery painful?

Achilles surgery shouldn’t be painful since you’ll likely be under anesthesia. You may have a moderate to high amount of pain after your procedure for a few days to weeks.

Is it normal to feel stiffness after Achilles surgery?

It’s typical for your ankle to feel stiff while you’re recovering due to reduced movement. This stiffness should improve throughout your rehabilitation.

Doctors often recommend Achilles surgery for tendon tears larger than half the width of your tendon. Doctors can choose from various surgical techniques, and some debate remains over which technique is best.

You might walk the way you usually do roughly 3–4 months after your surgery and return to sports after about 6 months. The level of sport activity people can return to varies.