For most people, a boot with early rehab gives about the SAME result at one year as surgery. Surgery lowers the chance of the tendon tearing again. The boot avoids the risks of an operation.
In a large recent trial, about 6 in 100 people treated in a boot re-tore the tendon within a year, compared with fewer than 1 in 100 after surgery. But surgery brought its own problems, mainly nerve injury in about 3 to 5 in 100.
Whichever you choose, full recovery takes about a YEAR, and some people need closer to two years to reach every goal.
How it happens
- The classic story: a sudden push-off, lunge or jump, often in racket sports or basketball, and it feels like someone kicked you in the back of the heel
- A pop or snap: many people hear or feel it, then turn around to see who hit them
- Afterward: you can often still walk, flat-footed, but you can’t rise onto your toes on that leg
- It’s easy to miss: because you can still move the foot, it sometimes gets called a sprain. Tell whoever sees you exactly how it happened
If the pain in your Achilles built up slowly over weeks, that’s more likely tendinopathy. See Achilles tendinitis.
Surgery or boot: how to decide
- Boot with early rehab: you start with the foot pointed down in a boot with heel wedges, and the wedges come out over several weeks. You walk on it early. No wound, no anesthetic, and a very low chance of nerve injury
- Surgery: the tendon ends are stitched together, through an open cut or small keyhole cuts. The main gain is a lower chance of re-rupture. Risks include wound problems, infection and nerve injury causing numbness on the outside of the foot
- At one year: trials comparing the two find similar function and similar daily-life scores
- Surgery may be favored if: treatment is delayed, the tendon ends stay far apart on scan with the foot pointed, the tear is near the heel bone, or you’re a high-level athlete. Discuss it with your surgeon
- A boot may be favored if: you smoke, have diabetes or poor circulation, or want to avoid an operation
The choice you make matters less than the rehab you do after it.
Recovery timeline
- Weeks 0 to 2: boot or cast with the foot pointed down. Foot up as much as you can. Crutches, and weight as your team allows
- Weeks 2 to 8: walking in the boot, wedges removed step by step. Gentle ankle movement starts, within the limits you’re given
- Weeks 8 to 12: out of the boot into a shoe, often with a small heel lift. Walking without a limp takes practice
- Months 3 to 6: calf strength is the main work: heel raises on two legs, then one. Cycling and swimming
- Months 6 to 12: jogging when you can do repeated single-leg heel raises. Hopping and jumping come later
- Return to sport: often around a year for running and jumping sports, and longer for high-level athletes
Your surgeon or physio may use a different schedule. Use theirs.
What to expect long-term
- Calf strength may stay reduced: many people keep some weakness when pushing off or jumping, even years later. Keep doing heel raises after rehab ends
- A thicker tendon: the healed tendon usually stays wider than the other side. That’s normal
- Don’t overstretch: a tendon that heals too long is weak. Avoid hard calf stretching early unless your team asks for it
- Most people return to walking, work and recreational sport. The American Academy of Orthopaedic Surgeons notes that complete recovery takes about 12 months
Clot risk
A leg in a boot, moving less than usual, is at higher risk of a blood clot in the calf. Your team may give you blood-thinning injections or tablets. Move your toes and knee often, and walk as much as you’re allowed.
Keeping the foot up in the first weeks also controls swelling, just as it does after foot surgery.
Get seen today if
- You think you’ve just ruptured it. Treatment works best when it starts within days
- Your calf is painful, swollen or warm: possible clot
- You’re short of breath or have chest pain: call emergency services
- You feel another pop, or suddenly can’t push off again during recovery
- The wound is red, spreading, leaking, or you have a fever
Get it checked if
- Numbness on the outside of the foot isn’t improving
- You still can’t do a single-leg heel raise by around six months
- The boot rubs or causes a sore on the skin
Surgery or boot joins the tendon. A year of calf work decides how well you push off.