If your Achilles tendon tears, do you need surgery?

Short answer

Not always. Surgery cuts the number of re-tears, but it adds infections and nerve injuries, and everyday function one year later showed no difference. Operating only on people whose tendon ends were far apart on ultrasound meant 36% fewer surgeries, with a re-tear rate of 3%.

If your Achilles tendon tears, do you need surgery?
'Torn tendon → surgery → full recovery' — does this formula hold?
The Achilles tendon links your heel to your calf muscles. When it snaps during a jump or a sprint, most people assume it has to be stitched. We checked studies that compared surgery with no surgery.
Does surgery mean fewer re-tears?
Yes, re-tears went down
An analysis that pooled 29 studies with 15,862 people found re-tear rates of 2.3% after surgery and 3.9% without it. That is a gap of about 2 in 100 people. A 2025 analysis pooling 14 randomized trials with 1,628 people also found a 70% lower re-tear risk after open surgery.
But other problems went up
Infections and nerve injuries were more common after surgery
In the same 15,862-person analysis, complications other than re-tears hit 4.9% after surgery and 1.6% without it. The biggest gap was infection (2.8%). In a trial of 554 people, nerve injuries occurred in 5.2% after small-incision surgery, 2.8% after open surgery, and 0.6% without surgery.
What about walking and running a year later?
There was no difference between the three options
A trial split 554 people into no surgery, open surgery, and small-incision surgery. After 1 year, a symptom and function score (out of 100) had dropped by 17.0, 16.0, and 14.7 points, with no difference between groups. Physical tests were similar too. Re-tears: 6.2% without surgery, 0.6% in each surgery group.
Calf strength was another story
After 18 months, the surgery group was 14% stronger
In a trial of 60 people who all did the same rehab, function scores at 18 months were 79.5 and 75.7, with no difference. But calf strength in the injured leg, measured on a machine, was 14% higher after surgery. Depending on the ankle angle, the gap was 10-18%.
Where does the strength gap come from?
The tendon healed longer than before
A study that followed 8 people for 1 year found the injured Achilles tendon healed 2.6-3.1 cm longer than the other side. Their heel rose 4.1-6.1 cm less when they went up on their toes. The longer the tendon, the lower the heel rise.
What if only wide gaps get surgery?
36% fewer operations, and a 3% re-tear rate
A 2026 trial split 300 people into three groups. One group got surgery only if ultrasound showed the torn ends overlapped less than 25% or the tendon had stretched 7% or more. This group had 36% fewer operations than the all-surgery group. Its re-tear rate was 3%, lower than the 11% in the no-surgery group.
Bottom line: surgery is not a must
It cuts re-tears and adds other risks
Surgery reduced re-tears by about 2 in 100 people, but it added infections and nerve injuries. Function scores 1 year later showed no difference, while calf strength was 14% higher after surgery. Operating only on people with widely separated tendon ends cut surgeries by 36% and held re-tears at 3%.