Chronic Achilles ruptures present a significant challenge for the treating physician. These patients often have marked impairment of functional activities and usually require surgical treatment to optimize outcome. This article reviews some of the methods that have been described to treat the chronic or neglected Achilles tendon rupture. The methods that have been used include gastrocnemius advancement, fascial turndown flaps, local tendon transfers, free tissue transfer, and use of synthetic grafts. There are no comparative data to guide evidence-based decision making in regard to choosing between treatment options.