Abstract Acute ruptures of the tendo Achillis are increasingly frequent, and affect mainly middle-aged adults. The optimal management of acute ruptures of the tendo Achillis is widely debated. The contentious issues can be summarised into conservative versus operative management, early versus late mobilisation and, if operative management is selected, percutaneous versus open repair. In general, rerupture is more common after non-operative management, and infections and skin healing complications are confined primarily to patients undergoing surgical repair. There is a dcfinite trend towards aggressive functional regimens, pushing the boundaries of aggressive functional rehabilitation. Early loading of the tendo Achillis favourably influences the maturation of collagen fibres within the tendon. Early weight bearing and functional bracing hasten recovery and return to normal activity, and have obvious practical benefits for patients, without increasing the risk of re-rupture. The best regime for any particular patient can he different. However, early weight bearing and mobilisation, whichever regime (conservative or operative) one opts for gives the best results, provided that the tendon ends are kept in contact.