Achilles Tendon Rupture (Part Four)

What is the outlook for a ruptured Achilles tendon?

In general, the outlook is good. However, the tendon takes time to heal, usually about six to eight weeks. More time will be needed after this to allow the muscles to regain their normal strength, as they have been in a cast or brace. Depending on the type of work, some people need a few weeks off work, and the time taken to return to sports is between 4 and 12 months.

Possible complications include:

• Regardless of the treatment option used, there is a chance that the Achilles tendon may not heal completely, and further treatment such as surgery may be required.
• Complications of surgery: these are usually minor complications such as an infection of the wound or reduced sensation near the site of surgery. About 4 in 100 people develop a wound infection after surgery to repair the ruptured Achilles tendon.
• The tendon may sclerose or become shorter during the healing process.
• There is also a chance that the tendon could re-rupture. According to some research studies, the risk of a re-rupture is about 4 in 100 with surgical treatment and about 12 in 100 with conservative treatment.

Can an Achilles tendon rupture be prevented?

Not always. However, here are some suggestions to help prevent this injury:

• For sports activities, start with warm-up exercises at the beginning.
• Corticosteroids (steroids) such as prednisolone should be used with caution and the dose should be reduced if possible. However, there are many conditions where corticosteroid treatment is important or life-saving.
• Quinolone antibiotics should be used with caution in people over 60 or those taking steroids.

Rehabilitation of Achilles Tendon Rupture.

General considerations:

The time frames mentioned in this protocol should be considered approximate with actual progress based on clinical presentation. Appointments with the doctor, as well as continuous assessments by the physiotherapist, should dictate progress.

Avoid strains of active and passive range of motion of the Achilles tendon for 10 - 12 weeks.

Carefully monitor the movements of the tendon and the surgical incision wound for signs of scar tissue formation. Regular soft tissue treatments (i.e., scar mobilization and friction massage) to reduce fibrosis.

All exercises should be carefully observed for signs of any compensation.
No running, marathons, jumping, or ballistic activities for 6 months.
General and aerobic exercise program throughout the rehabilitation process.
Doctor's appointments: Day 1, Day 8 - 10, 1 month, 2 months, 4 months, 6 months, 1 year post-op.

0 - 3 weeks:

Boot locked at 30° plantar flexion.
Non-weight bearing for 3 weeks – no pushing or walking on toes.
Control of pain and swelling (cryotherapy, electrical stimulation, soft tissue treatment).
Exercises for the toes, lifting the leg straight and up, flexion / extension of the knee.
Well-leg cycling, weight training, and swimming for cardiovascular conditioning.

3 - 8 weeks:

Gradually increase weight bearing by touching the ground with toes partially, as tolerated. After 6 weeks, progress to full weight bearing.
Orthosis or Boot locked at 5° to 10° plantar flexion. After 8 weeks, OK to wear shoes or boots with heels (cowboy boots or with "raised 1/4 heels).
Isometric exercises of the unaffected muscles, active gentle dorsiflexion of the ankle to gentle tension of the Achilles tendon. Slowly increase the intensity and range of the Achilles isometric exercises within the range of the locked boot.
Gradually increase passive range of motion and Achilles tension after 6 weeks.
Proprioception exercises, strengthening of inner muscles, PNF patterns (not of the Achilles).
At 6 weeks, OK to add stationary cycling pushed only with heels.
Daily soft tissue treatments.

8 - 12 weeks:

Full weight bearing with shoes or boots with heels as tolerated, and walking training.
Transition to regular shoes over a 2 - 4 week period.
Begin to gradually increase active / resistive exercises of the Achilles.
Full Manual passive range of motion of the Achilles tendon - nothing forceful.
Progress to cycling with shoes, swimming.

3 - 6 Months:

6 Months:

Progressive running / jumping exercises, and eccentric loading exercises, non-competitive sports activities, sports-simulated exercises.

8 - 9 Months:

Return to sports activities and/or work that requires physical effort.

NOTE: All progressions are approximate and should be used as a guide only. Progress will be based on the individual presentation of the patient, which is evaluated throughout the treatment process.