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Background: We present the results of a single-center, single-surgeon study in 59 patients with a fresh (4 women and 23 men; mean age, 43.6 ± 8.8 years) or a neglected (1 woman and 21 men; mean age, 41.3 ± 7.4 years) Achilles tendon rupture. Methods: Patients with a fresh rupture were operated on using end-to-end suture, and patients with a neglected rupture received the tendon of the peroneus brevis as an autologous graft. Patients were assessed during the sixth postoperative week, and during the sixth postoperative month. They were discharged within 1 year after the operation, and were reviewed at an average of 53 ± 13 months after surgery. Results: Patients were generally satisfied with the procedure, but those with a neglected rupture tended to have a greater postoperative complication rate, greater loss of isokinetic strength variables at high speeds, and greater loss of calf circumference. Conclusion: The management of acute and neglected subcutaneous tears of the Achilles tendon by peroneus tendon transfer is safe but technically demanding. It affords good recovery, even in patients with a neglected rupture of 6 weeks' to 9 months' duration. Patients with a neglected rupture are at a slightly greater risk of postoperative complications, and their ankle plantar flexion strength can be reduced.