Foot and ankle surgery · London
Achilles tendon repair, by a specialist foot and ankle surgeon.
A same-week theatre slot for acute ruptures across our London network. Mini-open percutaneous PARS, open Krackow or chronic FHL reconstruction, weighed honestly against non-operative functional bracing.
Why patients choose us
- 01
A specialist foot and ankle surgeon, not a generalist
A consultant with a dedicated Achilles caseload, in a unit that runs a same-week trauma pathway. Not the on-call orthopaedic list.
- 02
Surgery or bracing, honestly compared
UKSTAR and Willits show similar re-rupture and function for non-op vs open repair. We put both on the table with real numbers.
- 03
Independent, and free
We are paid by no hospital, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private Achilles repair costs in London.
Indicative ranges across our London network. Send a short account of the injury and any imaging and we quote firm figures across two or three options.
In short
Mini-open PARS repair in our network: £8,500 to £14,000, home the same day.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation, ultrasound and treatment plan | £350–£650 | 45–60 min | Same visit |
| Non-operative functional bracing programme | £850–£2,400 | 10 weeks in boot | Fitted same week |
| Mini-open percutaneous repair (PARS / SpeedBridge) | £8,500–£14,000 | 45–60 min | Day case |
| Open Krackow repair | £7,500–£12,500 | 60–75 min | Day case |
| Chronic reconstruction with FHL tendon transfer | £14,000–£22,000 | 90–120 min | 1 night stay |
| Second-opinion review of prior imaging | £250–£450 | 30 min | 48 hours |
Prices vary by hospital, by which surgeon does the case, and by whether the repair is acute or a chronic reconstruction. We come back with a firm quote within one working day.
The journey
From injury to running again - what happens, in order.
One team from your first enquiry to your final physio review at six months.
- 01
Before
Send us the story and any imaging
How and when it happened, a short video of the calf if you can, and any ultrasound or MRI. Time from injury matters: the first two weeks change the options.
- 02
Before
We come back with a recommendation
Within one working day: surgery vs functional bracing, indicative price, and which two or three surgeons fit the case. An honest read either way.
- 03
Before
Ultrasound to confirm the gap
Dynamic ultrasound in plantarflexion measures the tendon gap and guides the decision. MRI is added for chronic or re-rupture cases.
- 04
On the day
Day-case surgery under GA and block
45 to 60 minutes, general anaesthetic with a popliteal block for 18 hours of pain relief. Home the same day in an equinus splint.
- 05
On the day
Or fitted for a CAM boot
If we go non-op, a full equinus CAM boot with heel wedges is fitted the same day, with a written weaning schedule and a physiotherapy referral.
- 06
After
Progressive loading, weeks 2 to 8
Partial weight-bearing from week 2 to 4, wedges removed one at a time, boot off at 8 to 10 weeks. Same schedule whether you had surgery or bracing.
- 07
After
Return to running at 4 to 6 months
Structured physio through months 3 to 6, straight-line running from month 4, cutting sports from month 6. Full strength recovery takes a year.
When it helps
When Achilles repair is the right step - and when it is not.
The presentations we see most, plus the situations that push the decision one way or the other.
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Acute mid-substance rupture
The classic case: a sudden pop during a push-off in tennis, squash or football, a positive Simmonds-Thompson test, palpable gap 2 to 6 cm above the insertion.
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Delayed presentation (2 to 6 weeks)
A rupture missed at A&E or self-managed as a calf strain. The tendon ends have retracted and non-op bracing is no longer reliable.
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Chronic rupture beyond 6 weeks
Fixed gap, weak push-off, unable to single-leg heel raise. Needs reconstruction with FHL tendon transfer rather than end-to-end repair.
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Insertional avulsion from the calcaneus
Tendon torn off the heel bone with a bony fragment. Repaired with suture anchors into the calcaneus rather than tendon-to-tendon sutures.
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Re-rupture after previous treatment
A second rupture at the same site after surgery or bracing. Reconstruction pathway rather than simple repair, with a longer boot programme.
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Athlete, high functional demand
A competitive runner, tennis player or footballer who needs a predictable return to sport. Mini-open repair with early functional rehab is the usual choice.
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Older or comorbid patient
Diabetes, peripheral vascular disease, smoker or thin skin over the tendon. Functional bracing usually preferred to avoid wound-healing problems.
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Red flag: numbness or foot pallor
A cold, pale, numb foot after the injury is a vascular emergency, not a tendon problem. Go to A&E the same day.
Procedure options
Mini-open, open, reconstruction - or a boot.
What each option on the table actually involves - and which fits which rupture.
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Mini-open percutaneous PARS (Arthrex)
A 2 cm incision, a jig delivered percutaneously through the paratenon, four locking sutures placed without opening the tendon sheath. Low wound and sural nerve complication rate.
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DePuy Synthes SpeedBridge
A mini-open technique using knotless suture anchors into the calcaneus for insertional ruptures and augmented mid-substance repairs. Immediate stable fixation.
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Open Krackow repair
Traditional 8 to 10 cm posteromedial incision, a locking Krackow stitch in each tendon end tied under anatomical tension. The workhorse for surgeons without the mini-open kit.
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Chronic reconstruction with FHL transfer
The flexor hallucis longus tendon is harvested, tunnelled through the calcaneus and woven into the Achilles remnant. Restores push-off when a fixed gap prevents end-to-end repair.
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Non-operative functional bracing
Equinus CAM boot with three heel wedges, non-weight-bearing week 0 to 2, partial weight-bearing week 2 to 4, wedges removed one at a time, boot off at 8 to 10 weeks. UKSTAR protocol.
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Popliteal block plus GA
A single-shot popliteal nerve block gives 18 to 24 hours of pain relief and lets you go home the same day. Standard alongside general anaesthetic for all our surgical cases.
Our London network
A small panel of foot and ankle surgeons, we picked them.
Consultant surgeons with a dedicated Achilles caseload, across the London units below. Introductions are made privately, once we understand your case.
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Consultant foot and ankle surgeons with a dedicated Achilles caseload
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Same-week ultrasound and theatre slot for acute ruptures
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PARS, SpeedBridge and open Krackow techniques all available
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Chronic reconstruction and FHL tendon transfer offered when indicated
London centres we work with
- Fortius Foot and Ankle (Marylebone)
- London Foot and Ankle Centre (Wellington Hospital)
- HCA The Wellington Hospital (St John’s Wood)
- Cromwell Hospital BUPA (South Kensington)
- London Bridge Hospital (Southwark)
- Chelsea and Westminster Private (Fulham Road)
Safety and recovery
What to expect afterwards - honestly.
The trade-offs that matter: re-rupture, wound complications, sural nerve, DVT prophylaxis, and the shared rehab schedule.
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Re-rupture rate 3 to 6%
UKSTAR (2020) and Willits (2010) show similar re-rupture rates for surgical repair and functional bracing when both use accelerated rehab. Not a reason to default to surgery.
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Wound complications after open repair
Wound problems occur in 5 to 10% of open Krackow repairs. Mini-open PARS drops this below 2%. Bracing avoids wound risk entirely.
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Sural nerve injury
Numbness on the outside of the foot from sural nerve irritation. Around 4% with open repair, 1 to 2% with modern PARS jigs, close to zero with bracing.
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Deep vein thrombosis prophylaxis
Ten days of low molecular weight heparin injections or oral rivaroxaban. Standard for any patient in an equinus boot, surgical or non-op.
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Same rehab whichever route
The UKSTAR protocol is used for both surgical and non-op patients: equinus boot, progressive dorsiflexion, weight-bearing at week 2. Physio-led, not surgeon-led.
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Return to sport at 6 months
Straight-line running from month 4, cutting sports and jumping from month 6. Full strength and endurance recovery takes 12 months whichever route you take.
Recognised by major UK insurers
Cover for Achilles repair varies by insurer - usually funded when medically indicated. We confirm cover before booking.
Frequently asked
Everything we get asked about Achilles repair.
Quick answers on surgery vs bracing, costs, recovery and chronic ruptures.
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How do I know if I have ruptured my Achilles?
The classic story is a sudden pop or a feeling of being kicked in the back of the calf during a push-off, followed by weakness and inability to rise onto the toes. Examination shows a positive Simmonds-Thompson test (no plantarflexion when the calf is squeezed) and often a palpable gap 2 to 6 cm above the heel. Dynamic ultrasound confirms the gap and measures it in plantarflexion, which guides the decision between surgery and bracing.
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Do I need surgery, or is functional bracing just as good?
For most acute mid-substance ruptures treated within two weeks, UKSTAR (Lancet 2020) and Willits (JBJS 2010) show similar re-rupture rates of 3 to 6% and similar functional outcomes at one year for surgery vs functional bracing with equinus CAM boot and accelerated rehab. Surgery avoids no re-ruptures but adds a 5 to 10% wound complication rate with open repair, or 1 to 2% with mini-open PARS. High-demand athletes and delayed presentations still tend towards surgery; older or comorbid patients tend towards bracing.
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What does a private Achilles repair cost in London?
Roughly £8,500 to £14,000 for a mini-open percutaneous PARS or SpeedBridge, £7,500 to £12,500 for an open Krackow repair, and £14,000 to £22,000 for a chronic reconstruction with FHL tendon transfer. Non-operative bracing with a full physio programme is £850 to £2,400. A firm quote is confirmed within one working day.
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How long is the recovery, and when can I run again?
Ten weeks in an equinus CAM boot whether you have surgery or bracing, with partial weight-bearing from week 2 to 4 and progressive dorsiflexion as wedges are removed. Physiotherapy through months 3 to 6. Straight-line running from month 4, cutting sports and jumping from month 6. Full strength and endurance recovery takes 12 months.
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Which London hospitals do you work with for Achilles repair?
We arrange treatment across Fortius Foot and Ankle in Marylebone, the London Foot and Ankle Centre at the Wellington, HCA The Wellington Hospital in St John’s Wood, Cromwell Hospital BUPA in South Kensington, London Bridge Hospital in Southwark, and Chelsea and Westminster Private on Fulham Road. Which one you go to depends on your surgeon, your insurer and how quickly we need a theatre slot.
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What if my rupture is more than six weeks old?
A chronic rupture beyond six weeks usually has a fixed gap between the tendon ends that is too wide to close directly. The reliable operation is a reconstruction with flexor hallucis longus (FHL) tendon transfer: the tendon that flexes your big toe is rerouted through the calcaneus and woven into the Achilles remnant to restore push-off. It is a 90 to 120 minute operation with a one-night stay and a slightly longer rehab, but recovery of function is very good.
Same-week theatre slot
Ruptured your Achilles? Tell us today.
The first two weeks change the options. Send us a short account and any imaging - we come back within one working day with two or three surgeons, indicative pricing and a theatre date.
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