Do Achilles Tendon Injuries Need Surgery?
The Achilles tendon is the thickest and strongest tendon in the body — but it’s not indestructible. Whether you’ve experienced a partial tear, full rupture, or chronic tendinopathy, the question often arises: Do I need surgery to recover? The answer depends on the type of injury, the degree of damage, and your performance goals. In many cases, surgery is avoidable. This article explores the latest evidence on managing Achilles injuries effectively.
Do Achilles Injuries Always Require Surgery?
No — not all Achilles injuries need surgical repair. In fact, many cases, including full ruptures, can be successfully treated non-surgically with structured rehabilitation protocols.
Injuries That Usually Don’t Require Surgery:
• Mid-portion tendinopathy (chronic irritation/inflammation)
• Insertional Achilles tendinopathy (pain at the heel)
• Partial tears with intact continuity and manageable symptoms
• Non-sporting full ruptures in sedentary individuals or those with low physical demands
Injuries That May Require Surgery:
• Complete Achilles rupture in athletic populations, especially if early rehab is not an option
• Failed conservative rehab after 3–6 months of structured loading
• Large partial tears with poor healing potential
• Chronic ruptures that were missed or misdiagnosed and have poor functional recovery
Rehab vs. Surgery: What Does the Evidence Say?
Multiple studies and meta-analyses now show that non-surgical treatment of Achilles ruptures — particularly when combined with early functional rehabilitation — can produce outcomes equivalent to surgical repair in terms of strength and return to sport.
However, timing is crucial. Early diagnosis and the use of accelerated loading protocols (e.g., early weight-bearing in a controlled boot and progressive strengthening) are key to non-surgical success.
Surgery may still be preferred in:
• Athletes needing to minimise re-rupture risk
• Cases with tendon retraction >5 cm
• Delayed diagnoses where the tendon has already scarred in a lengthened position
FAQs
Q: Can a completely torn Achilles tendon heal without surgery?
A: Yes, provided the tear is diagnosed early and a structured, early rehab protocol is followed. Immobilisation alone without functional rehab often leads to poor outcomes.
Q: How long does it take to recover from a non-surgical Achilles rupture?
A: Most non-surgical protocols take 9–12 months for a full return to sport. Everyday function can return within 3–6 months depending on the rehab plan.
Q: What are the risks of not having surgery?
A: Slightly higher re-rupture risk if rehab is delayed or done poorly, and some cases may develop elongation of the tendon affecting push-off strength.
Q: What’s the difference between tendinopathy and a tear?
A: Tendinopathy is chronic overload or degeneration without a specific tear. A tear (partial or full) involves structural damage to the tendon fibres.
Q: Can you still train with Achilles pain?
A: Yes, with modifications. Isometric loading, controlled eccentrics, and offloading strategies (e.g. heel lifts, cross-training) can allow continued training while rehabbing.
Summary
Surgery is not the only — or even the best — option for many Achilles injuries. With early diagnosis and expert rehab, most people recover full function without going under the knife. At Poseidon Performance, we guide clients through progressive, evidence-based recovery protocols to restore performance, reduce re-injury risk, and avoid unnecessary surgery.
