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The Achilles Tendon Acute Rupture
The
Achilles Tendon Acute Repair
POSTOPERATIVE
BRACING
REHABILITATION
PROTOCOL
Links
of interest
The
Achilles Tendon Acute Repair
| Achilles Tendon Rupture |
Note the defect in the tendon |
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| Anatomy |
The surgery |
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| The ruptured tendon |
After the repair |
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| The Skin incision closed |
The Orthosis (splint) applied soon after the
surgery. |
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POSTOPERATIVE
BRACING
REHABILITATION
PROTOCOL
General
Considerations
Time
frames mentioned in this protocol should be considered approximate
with actual progression based upon clinical presentation.
Physician appointments as well as continued assessment by the
treating practitioner should dictate progress.
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Avoid
forceful active and passive range of motion of the Achilles for 10 -
12 weeks.
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Carefully
monitor the tendon and incisions for mobility and signs of scar
tissue formation. Regular
soft tissue treatments (i.e. scar mobilization and friction massage)
to decrease fibrosis.
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All
exercises should be carefully observed for any signs of compensation
or guarding.
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No
running, jumping, or ballistic activities for 6 months.
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Aerobic
and general conditioning throughout the rehabilitation process.
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Orthopaedic
Surgeon appointments at Day 1, Day 8-10, 1 month, 2 months, 4
months, 6 months, and 1 year post-operatively.
0
- 3 weeks
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Adjustable
boot locked out at 30 of plantar flexion.
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Non-weight
bearing for 3 weeks--no push off or toe-touch walking.
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Pain
and oedema control (i.e. ice and soft tissue treatments).
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Toe
curls, toe spreads, gentle foot movement in boot, straight leg
raises, knee flexion/extension.
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Well-leg
cycling, weight training, and swimming for cardiovascular
conditioning.
3
- 8 weeks
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Gradually
increase weight bearing from toe-touchdown to partial as tolerated.
After 6 weeks, okay to progress to full weight bearing.
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Walking
orthosis adjusted 5 degrees a week until 10 degrees of plantar
flexion. After 8 weeks,
okay to wear shoes with a heel (i.e. riding boots, 2.5 cm heel lift
in shoes).
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Isometrics
of uninvolved muscles, light active dorsiflexion of the ankle until
gentle stretch of Achilles.
Slowly
increase the intensity and ranges of isometrics of Achilles within
the range of the boot.
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Slowly
increase passive range of motion and stretch on the Achilles after 6
weeks.
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Proprioception
exercises, intrinsic muscle strengthening, PNF patterns (not to
Achilles).
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At
6 weeks, okay to add stationary cycling with heel push only.
Deep water workouts.
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Soft
tissue treatments daily
8
- 12 weeks
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Full
weight bearing with heel lift as tolerated, gait training.
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Wean
into a regular shoe over a 2-4 week period.
-
Begin
and gradually increase active / resistive exercises of the Achilles
(i.e. sub maximal isometrics, cautious isotonic, Theraband).
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Manual
full passive range of motion of the Achilles--nothing forceful.
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Progress
to cycling in shoe, swimming.
3
- 6 months
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Wean
off heel lifts (if not already).
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Closed
chain exercises: controlled squats, lunges, bilateral calf raise
(progress to unilateral), toe raises, controlled slow eccentrics vs.
body weight.
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Cycling,
rowing machine.
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Unless
excessive fibrosis present, should be discharged into a home
program.
6
months
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Progress
training jogging / running, jumping and eccentric loading exercises,
non-competitive sporting activities, sports-simulated exercises.
8-9
months
Links
of interest
http://www.arthroscopy.com/sp09009.htm
http://www.clark.net/pub/pribut/spachil.html
http://www.healthinformatics.com/docs/english/SMA/achilles.sma.asp
http://www.medicalmultimediagroup.com/pated/foot/achilles/achilles.html
http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/achillestotal.htm
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