Torn Achilles Recovery Guide: Boot vs Cast, Surgery Timeline & Sleeping Tips

Achilles walking cast vs boot – which is better?

The beauty of the boots is that they can be removed (for a wash or to scratch an itch). Check our

for more on choosing the right boot.

The danger of the boots is that they can be removed (at which point the Achilles is at risk of re-injury).

So - boots are both good and bad!

Boots are convenient and safe – as long as they are used properly and you don't cut corners. Misuse may lead to a re-rupture of the tendon, which usually requires an operation. Then you have to start the recovery all over again. This is extremely frustrating.

Which Achilles tendon rupture boot is best?

Boots come in two different designs. Both are shaped to hold your ankle in a tip-toes position. This brings the torn tendon ends together to allow healing.

Wedges are used in some boots to lift the heel. As the weeks of recovery pass, the number of wedges (and so the height that the heel is lifted to) is gradually reduced.

Hinges are fitted to other boots. The angle of the hinge is adjusted towards a flatter foot posture as recovery progresses.

Nobody knows for certain whether one or other style is better for recovery. Both types of boot work very satisfactorily; as long as they fit well and are used properly.

How to sleep comfortably with an Achilles rupture boot?

Yes, you DO need to maintain a tip toe position at night. You must either use your boot or consider a Thetis Achilles Night Splint. If you take the boot or splint off, then the healing tendon is at high risk of re-injury.

Sleeping in the hot and heavy boot is the most common complaint from patients recovering from an Achilles tendon rupture. The specially designed

, from Thetis Medical solves these problems.

Sleeping in the boot brings other problems. Since you are walking on it during the day, the bottom of the boot inevitably gets dirty. Some boots have a detachable sole, but this leaves sharp plastic edges. The Thetis Achilles Splint avoids this too. Another solution is to put the injured leg, inside the boot, into an old pillowcase. This protects the other leg from being scratched by the plastic and straps. It also keeps the bed clean.

How long for an Achilles tendon rupture to heal?

Whether the tendon is treated with surgery, or allowed to mend naturally in a boot, the healing time is long. It is usual to spend 10 weeks in a plaster cast or boot. After this, healing is sufficiently advanced to allow walking without the boot, and physiotherapy begins. However, the tendon is not at full strength even then. Re-rupture is still possible. Competitive sport is not advised until at least six months from injury.

Recovery time with and without surgery?

There is no difference. Surgery does not make the recovery from a torn Achilles tendon any quicker. The goal of surgery is just to ensure that the two ends of the torn tendon sit close together, so that natural healing can occur. The stitches are not strong enough to support body weight. Activity without the protective boot or cast cannot commence until the tendon has had sufficient time to heal.

Partial Achilles tear recovery

The Golden Rule is that there is NO SUCH THING as a partial tear of the Achilles tendon. Assume you have a complete rupture of the tendon until a specialist has assessed your injury. (A partial tear can in fact occur but is extremely rare).

Achilles tendon recovery/rehab exercises

Your physiotherapist will guide you through the stages of recovery. The goal is to build the calf muscle strength. Lots of heel lifts/tip toe exercises are required, before advancing to a return to sport program. All this takes at least six months. It is important to avoid stretching exercises even if the tendon feels tight. With time it will always gradually stretch a little.