When the Achilles tendon is completely or partially torn, surgery is an option. However, conservative treatment can also be applied successfully in case of this diagnosis.

1. Complete Achilles tendon tear: operating techniques
2. Partial Achilles tendon tear: is Achilles tendon surgery really necessary or does conservative treatment help?
3. Rehab after Achilles tendon surgery and conservative treatment
4. Achilles tendon surgery or conservative treatment
5. Is Achilles tendon surgery necessary in the case of Achilles tendon inflammation/degeneration?

Achilles tendon surgery: techniques, duration, rehabilitation following surgery

Many experts prefer the open surgery technique, especially in the case of top athletes. Your GP will discuss the best treatment with you.

Achilles tendon surgery must take place as soon as possible after a complete Achilles tendon tear. A partial Achilles tendon tear can also be operated on or treated conservatively.

• Mini-open/percutaneous: the ends of the tendon are sewn together through one or more small incisions in the skin.
• Open technique: a longer incision is made in the skin through which the Achilles tendon is sewn using different techniques.

Hospital admission, inability to work, fitness for sport

Mini-open/percutaneous:

• Achilles tendon surgery can be carried out as outpatient surgery or with several days of hospital admission (approx. 4 days on average, depending on healing and possible complications)
• inability to work: approx. 8 weeks on average*
• fitness for sport: in approx. 5 months**

Open technique:

• Open technique: hospital admission approx. 7–14 days (depending on healing process and complications)
• inability to work: approx. 8–12 weeks
• fitness for sport: in approx. 6 months**

*Please note: inability to work can of course vary greatly and depends on:

• the healing process
• the type of work or physical demands.
• Returning to work part time may be a sensible option to begin with.
• **Please note: it is difficult to gauge when it will be possible to return to full-weight-bearing exercise within the scope of Achilles tendon treatment as it depends on:
• the surgeon and the operating technique applied
• the healing process, which differs from one person to the next and of course also depends on the methods used
• the type of exercise. In the case of sporting activities with predominantly cyclical movements, such as jogging, the process is faster (the above-mentioned four to five months); in the case of sports involving higher loads, such as jumping and all sports with rapid changes of direction and sudden stops and acceleration, it normally takes longer.

So, please discuss with your therapist when it will be possible to resume activity!

Rehabilitation following Achilles tendon surgery whereby the foot is in a cast is generally speaking a thing of the past. Today’s strategy is called early functional rehabilitation.

Early = as soon as possible after the Achilles tendon surgery.

Functional = with exercises that are typical for the normal work and function of the Achilles tendon.

But be careful! You should not do too little or too much in each healing phase. Practice makes perfect and is perfect for healing an Achilles tendon. However, you must ensure that the Achilles tendon is not placed under too much strain and that the healing – adhesion of the ends – does not go wrong, and that the Achilles tendon does not tear again.

Both measures appear to have similar results in terms of Achilles tendon function and potential new tears.

All tendons are highly likely to adhere even without Achilles tendon surgery. What is important is that at the end of the process the tendon is the same length as before.

So that the tendon ends are ‘at rest’ in the beginning and can adhere, the foot is placed in an equines position and a special shoe is worn. Weight can then be put on the foot – early functional. To begin with only partial weight bearing should be applied, however, after a week this may progress to full-weight-bearing activity.

Rehabilitation after Achilles tendon surgery or conservative treatment can be carried out as an outpatient or inpatient. What is important is that a physiotherapist is by your side from the beginning with all Achilles tendon treatment options. They will not only massage the Achilles tendon, but above all will help the Achilles tendon, foot, leg and whole body to resume normal movement, so that the original function is gradually recovered. Among other things, this prevents you from falling into the wrong gait pattern. If such a gait pattern can be stored in the brain, it is very difficult to correct.

In conservative Achilles tendon treatment especially, it is extremely important that you collaborate as you should: not too much, not too little, but on a regular basis.

You should discuss this with your doctor and physiotherapist. They know what is best in YOUR PARTICULAR CASE. Generally spoken, the following criteria can be used:

• What is the exact diagnosis (what type of Achilles tendon tear, where, etc.)?
• How many parts of the Achilles tendon are torn?
• How likely is healing to be impaired or how high is the risk of infection? If the risks are high, conservative treatment is better.
• Are you a competing or professional athlete? Then surgery is preferable.

In any case, consistent, early functional rehabilitation makes sense, that is, the patient should be back on their feet as soon as possible and increase movement and load according to the healing phase.

All tendons, including the Achilles tendon, tend to lengthen after a tear. And a lengthened Achilles tendon does not work properly. It can result in reduced propulsion and limited hindfoot stability. This can be counteracted with early functional rehabilitation. Your own contribution is crucial to the success of your rehabilitation!

Surgery is often requested in the case of Achilles tendon inflammation. However, the Achilles tendon is normally degenerated and not inflamed. For this reason, we use the term tendinopathy, which means that the Achilles tendon is degenerated. This is the most common Achilles tendon complaint.

If conservative treatment of the tendinopathy is unsuccessful, Achilles tendon surgery may be an effective solution. In this case, both the mini-open technique and the open technique may be considered.