About 20 years ago, we came up with a Rapid Recovery treatment for Achilles Rupture patients – the patients typically had their injury between one day and two weeks prior to surgical repair of the tendon. At two weeks after surgery – the skin sutures are removed, the patient allowed to weight bear in a cam boot, and to take the boot off for bed, and to do an exercise program. The boot is typically used until eight weeks from surgery.

Some centres have taken up an interest in non operative care. The best instances of that require the leg being put in a plaster with the toes pointing down within 24 hours of the injury.

Metanalysis of 29 studies in was published in the BMJ 2019. Re-repture rate: 2.3% in operative group, 4.2% in non operative group Complications: only reported for operative group – infection 2.3% and wound dehiscence. Other complications like blood clots occurred in both groups. Return to sports claimed to be the same at six to nine months from injury. A more recent metanalysis says the same thing.

Our surgical treatment may not reflect “average” care from these studies. In their study only seven of 29 studies allow weight bearing before 4 weeks. Only six did the accelerated rehabilitation program. We routinely get people weight bearing in a boot at two weeks from surgery, and taking the boot off at night, and taking it off to move the ankle and do their exercises. We don’t offer this treatment to smokers, or poorly controlled diabetics to avoid the infection risks. We use dissolving sutures within the Achilles tendon – to minimise risk.

References:
Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5120 (Published 07 January 2019)

Achilles Tendon Rupture Treatment Systematic Review and Meta-analysis Foot Ankle Orthop. 2025 Apr 29;10(2):24730114251327219. doi: 10.1177/24730114251327219.eCollection 2025 Apr.

David Mitchell
Orthopaedic Surgeon