Introduction: Tendon Achilles injury is a common foot and ankle injury in the middle-aged population, especially between the age group of 30–46 years. This is important to recognize early and treat as salvage options have consistently poor outcomes. The incidence of acute tendon rupture (ATR) is on rising worldwide. Men are more prone to ATR when they try to get back to some fitness in the middle ages by playing dynamic sports like badminton, tennis, etc. We looked at the current concepts in the management of acute tendon Achilles injury. Method: We looked at the evidence of management, both surgical and nonsurgical options in detail and discussed the pros and cons of each modality. There are both advantages and disadvantages but the new evidence is tilting toward functional rehabilitation. Conclusion: This provides a systemic approach to clinicians in decision-making about the management of ATR in their patient group and recommends functional treatment as our choice in the majority of patient groups.