Achilles tendon ruptures are injuries that significantly affect lower extremity function and require treatment planning to be tailored to patient-specific characteristics. The primary objective of treatment is to restore the anatomical length of the tendon, preserve plantar flexion strength, and enhance functional capacity. Treatment selection should be individualized by collectively evaluating the time elapsed since injury, the size and morphology of the defect between the tendon ends, and the patient`s functional goals. Satisfactory outcomes have been reported with a non-surgical approach when supported by appropriate patient selection and structured early rehabilitation. Minimally invasive techniques offer an option aimed at reducing the risk of soft tissue-related complications in selected cases. Open surgical repair maintains its importance in cases where direct visualization of the tendon ends and a more reliable repair are required. In neglected ruptures, end-to-end repair may not always be feasible due to tendon end retraction and deterioration of tissue quality. In these cases, the surgical approach is directed toward reconstructive methods, including advancement and augmentation techniques, as well as tendon transfers, based on the size of the defect and tissue quality. The selection of the correct technique and the coordinated implementation of structured rehabilitation are fundamental components supporting the achievement of functional outcomes in both acute and neglected cases.