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Achilles tendon ruptures are commonly treated by foot and ankle surgeons. Optimal treatment remains controversial with good outcomes achieved with both operative and nonoperative methods. The traditional debate has focused on risk of rerupture following nonoperative care and risk of infection and wound complications after surgery. Using current treatment protocols both of these complications have decreased significantly. Traditional open surgical repair leads to excellent functional outcomes and, when performed with proper technique and layered closure, the risk of infection is minimal. This chapter discusses the authors’ indications, surgical technique and postoperative protocol for open repair of an Achilles tendon rupture.Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.