Above is an anatomical drawing of a calf from the back and side views. Medial stands for inner and lateral stands for outer. Recovery of the function of the gastrocnemius and soleus muscles is critical after an achilles tendon tear.
Disclaimer: While this is based on clinical research, it is for educational purposes only and should not be considered medical advice.
Achilles tendon injuries are no longer just a problem for elite athletes. Whether you’re an active parent, a weekend warrior, or someone who enjoys a morning jog, a torn Achilles can be a life-disrupting injury. One of the first questions patients ask is: “Do I have to get surgery?”
Let’s use a large, high-quality study published in the very best medical journal in the world: the New England Journal of Medicine, to have a clearer answer: you can indeed make a strong recovery without surgery—when paired with the right rehabilitation program.
📊 What Did the Study Show?
Researchers from Norway followed 526 patients between the ages of 18 and 60 who had an acute Achilles tendon rupture. Participants were randomly assigned to one of three groups:
- Nonoperative treatment (rehab and immobilization)
- Open surgical repair
- Minimally invasive surgery
They were all followed for at least 12 months, and the main outcomes measured were:
- Achilles tendon Total Rupture Score (ATRS): How well their symptoms and function improved.
- Physical performance tests
- Complication rates (like re-ruptures or nerve injuries)
🏁 Results at 12 Months:
- Function: All three groups improved equally well in terms of symptoms and function. No significant differences were found in the ATRS.
- Physical ability (jumping, heel raises, power tests): Similar results across all groups.
- Quality of life (mental and physical health): Again, no meaningful differences.
💡 Translation: Most people regained similar levels of function regardless of whether they had surgery or not.
⚠️ What About Risks?
🔁 Rerupture Risk:
- Higher in the nonoperative group (6.2%)
- Much lower in both surgical groups (0.6%)
This is important: while the chance of re-injury was slightly higher without surgery, it was still relatively low overall—especially with a modern rehab plan that includes early controlled weight bearing and movement.
🧠 Nerve Injuries:
- More common in patients who had minimally invasive surgery (5.2%)
- Lower in open surgery (2.8%)
- Rare in nonoperative treatment (0.6%)
🔍 What This Means for You
This study supports the idea that non-surgical recovery is a reasonable option, especially if:
- You follow a structured rehab protocol.
- You don’t require immediate return to high-impact sports.
- You’re not looking to return to elite competitive sports (e.g. elite conference Division I sports at the very least)
- You want to avoid the risks of surgery, such as infections or nerve damage.
- You don’t have a massive rupture.
But there are trade-offs. The small risk of re-injury without surgery is real, and some people may feel more confident in a surgically repaired tendon—especially athletes who plan to return to explosive movements.
🧘♂️ Recovery Without Surgery: What’s Involved?
Here’s what nonoperative recovery looked like in the study:
- Immediate casting (equinus position) to protect the tendon
- 6 weeks of gradual weight bearing in a walking boot with heel wedges
- Structured physical therapy after that (mobility, strength, proprioception)
- Avoiding early aggressive stretching or resistance that could stress the healing tendon
💡This approach mimics the latest evidence-based rehab protocols seen in high-performance sports settings.
🗣️ Final Thoughts
This landmark study confirms what many modern clinicians already suspected: surgery is not the only road to recovery after an Achilles rupture. In fact, with a committed rehab plan, many people do just as well without going under the knife.
However, decisions about surgery should be made on a case-by-case basis. Age, activity level, job demands, risk tolerance, and even timing of the injury can all influence the best choice.
If you or a loved one experiences an Achilles rupture, talk to your physical therapist and orthopedic surgical team. Ask about all your options—including evidence-based nonoperative rehab.
📚 Citation:
Myhrvold SB, Brouwer EF, Andresen TKM, et al. Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. N Engl J Med. 2022;386(15):1409–1420. DOI: 10.1056/NEJMoa2108447.