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Achilles Tendon Repair Rehabilitation Protocol

Timeframes for rehabilitation phases are a guide only and should be adapted to each individual patient’s progress, surgeon’s orders and with preference to err on the side of caution.

Treatment options listed are ideas only and should be adapted to each individual patient depending on age, function, sport, occupation and rehab goals.

Phase 1a: weeks 0 – 2

GOALS

  • Protect wound and tendon repair.
  • Control pain and swelling.

ORDERS

  • No physiotherapy or ankle ROM.

MANAGEMENT

  • Rest and elevate.
  • Gait aid prescription as appropriate.

Phase 1b: weeks 2 - 4

GOALS

  • Protect tendon repair.
  • Regain ankle ROM.

ORDERS

  • Partial weight bear increase to full weight bearing when comfortable in CAM boot (i.e. Begin with 2 crutches and reduce use as comfort/ balance improves).
  • Immobilised in CAM boot with 4 heel lifts (total height 1”) Removing one heel lift every 2 weeks.
  • CAM boot off for pain free exercise and showering only. Boot on in bed.
  • No active plantarflexion.
  • Active dorsiflexion to below ‘neutral ‘ only, with knee flexed.

MANAGEMENT

  • May begin physiotherapy between week 2- 4.
  • Active inversion, eversion and dorsiflexion AROM (to 15 degrees plantarflexion).
  • Gravity assisted plantarflexion ROM.
  • Hip and knee strengthening in CAM boot e.g. sit to stand, bridges.
  • Stationary bike in CAM boot.
  • Swimming freestyle with pull buoy (no active kicking)-after week 3-4 (and when wounds fully healed).

Phase 2a: weeks 4 – 6

GOALS

  • Protect tendon repair
  • Gradual increase light exercises

ORDERS

  • Continue to remove one heel lift from CAM boot every 2 weeks

MANAGEMENT

  • • Progress hip and knee strengthening in CAM boot e.g. controlled squats, step ups
  • Aim for foot to reach ‘neutral’ position (right angle with leg) only by 5-6 weeks post op.

Phase 2b: weeks 6-10

GOALS

  • Begin light Achilles / calf strengthening.

ORDERS

  • Remove forth heel lift at 6 weeks.
  • Remove final heel lift at 8 weeks.
  • No forceful stretching of Achilles.

MANAGEMENT

  • Graduated calf strengthening exercises e.g. Plantarflexion AROM, progressing to seated calf raises and theraband.
  • Inversion / eversion strengthening exercises e.g. isometrics, theraband.

Phase 3: weeks 10-12

GOALS

  • Wean CAM boot.
  • Increase anti-gravity
  • Achilles / calf strength.

ORDERS

  • Avoid flat footwear e.g. thongs or walking in barefeet
  • Use small heel raise in regular shoes.

MANAGEMENT

  • Supportive footwear e.g. runners with small heel.
  • Commence standing double leg heel raises.
  • Proprioception and balance exercises.
  • Graduated walking program.
  • Swimming unrestricted.

Phase 4: months 3 - 6

GOALS

  • Regain full calf strength / bulk.
  • Regain full calf length.
  • Regain normal gait.

ORDERS

  • Avoid plyometrics.

MANAGEMENT

  • Commence standing single leg calf raises and lunges, progress weight as tolerated.
  • Gastroc and soleus stretches.
  • Progress to light jogging from 4-6 months if no symptoms, adequate rehab and good calf strength regained.

Phase 5: months 6 – 12

GOALS

  • Return to normal sport / strenuous work.

MANAGEMENT

  • Sport / job specific training.
  • Progress strengthening, proprioceptive and balance training.
  • Jogging, running, jumping and plyometric exercise.

References: Kearney RS, McGuinness KR, Achten J & Costa ML. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy 2012; 98: 24-32.Suchak AA, Spooner C, Reid DC, Jomha NM. Postoperative rehabilitation for Achilles Tendon Ruptures: A Meta-analysis. Clin Orthop Relat Res. 2005; 445:216-221.

These notes have been prepared by orthopaedic surgeons at OrthoSport Victoria. They are general overviews and information aimed for use by their specific patients and reflects their views, opinions and recommendations. This does not constitute medical advice. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please seek the advice of your specific surgeon or other health care provider with any questions regarding medical conditions and treatment.