Although a 6week cast immobilization is common, many early functional. Most achilles tendon ruptures are treated surgically, especially with young athletes or active people. Achilles tendon rupture accelerated functional rehabilitation. This is true whether considering an operative or a nonoperative approach to the treatment of the acute achilles tendon rupture. Achilles tendon is the biggest and strongest tendon in the body. The achilles tendon usually rupt ures without warning.
Avoid all passive motion into df for 1st 6 weeks postop 3. The ideal is to achieve full symmetry in all 3 areas. The injury is often accompanied by an audible and palpable pop with limited ability to push off of the injured limb. Due to history and physical examination findings that were concerning for an achilles tendon rupture, the physical therapist immediately referred the patient to an orthopaedic surgeon. It attaches your two calf muscles gastrocnemius and soleus to the heel bone calcaneus and helps you go up onto tiptoes. Achilles tendon rupture atr is a common sports injury, with a rising incidence and significant impairments. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row. Operative versus nonoperative treatment of acute achilles tendon ruptures. Rehabilitation guidelines for achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. A pubmed search about the management of acute achilles.
This will result in weakness and loss of athletic ability. Postoperative rehabilitation protocols for achilles tendon. Achilles tendon rupture affects about 1 in 15,000 people at any one time, increasing to 1 in 8,000 in competitive athletes. Rom should be measure in both open and closedchain methods. Achilles tendon rupture accelerated functional rehabilitation protocol 0 2 weeks aircast boot with 2 cm heel lift nwb with crutches 2 6 weeks aircast boot with 2 cm heel lift protected weightbearing with crutches as required active plantar and dorsi flexion to neutral, inversion eversion below neutral. Other risk factors for achilles tendon rupture include use of fluoroquinolone antibiotics and direct steroid injections into the tendon. A closer look at a new protocol to manage achilles tendon. Achilles tendon rupture nonoperative treatment rehabilitation guidelines 02 weeks rest phase 1 goals rest, recovery and mobilise nonweight bearing safely on crutches. Chief, division of sports medicine associate professor of orthopaedic surgery tel. Achilles tendon rupture nonoperative rehabilitation protocol. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation of achilles tendon injury, diagnosis and treatment. It attaches your two calf muscles gastrocnemius and soleus to the heel bone calcaneus and.
Calf girth, plantar flexor strength and ankle rom are all. The optimal postoperative rehabilitation protocol after surgical repair of an achilles tendon rupture is unknown. Achilles tendon rupture diagnosis and treatment mayo clinic. It attaches the calf muscles soleus and gastrocnemius to the heel bone calcaneus. Achilles tendon repair rehabilitation postoperative guideline. The following is an example of a rehabilitation and exercise program for a complete achilles tendon rupture. It is designed for rehabilitation following post operative achilles tendon repair. Achilles tendon repair rehabilitation postoperative guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. You might also need to consult with doctors specializing in sports medicine or orthopedic surgery. People with an achilles tendon rupture commonly seek immediate treatment at a hospitals emergency department.
A rupture of the achilles tendon atr is a common pathology and it is the most commonly ruptured tendon in the human body. Achilles tendon rupture non surgical and surgical protocol last modified. Home patient info rehabilitation protocols achilles tendon rupture nonoperative rehabilitation protocol. A closer look at a new protocol to manage achilles tendon rupture. The pdf of the article you requested follows this cover page. Achilles tendon repair is performed after injury occurs to the achilles tendon. Evidence based management of acute achilles tendon. Department of physiotherapy department of sport and. Achilles tendon rupture repair return to sport protocol. The achilles tendon is the thick tendon above the heel that attaches the calf muscles to the heel bone. Achilles tendon rupture accelerated functional rehabilitation protocol 0 2 weeks aircast boot with 2 cm heel lift nwb with crutches 2 6 weeks aircast boot with 2 cm heel lift protected weightbearing with crutches as required active plantar and dorsi flexion to. The achilles tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. As such, it must be stressed that this is just a protocol and needs to not be a substitute for expert clinical decisionmaking regarding a patients development.
A new measurement of heelrise endurance with the ability to. Achilles tendon rupture, march 2018 3 patient information achilles tendon rupture conservative treatment functional bracing this is the use of a specialised boot that holds your leg in a set position to allow healing of the tendon while allowing you to function as normal. Rehabilitation guidelines for achilles tendon repair uw health. Kaar, md, william mitchell, md and lauren smith,pac department of orthopaedic surgery sports medicine and shoulder service. This protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. How to fix forward head posture 3 easy exercises from a chiropractor duration. Achilles tendon rupture conservative treatment protocol. Cole,md,mba weight bearing brace rom exercises phase i 02 weeks as tolerated with crutches and brace locked in full extension for sleeping and all activity off for exercises and hygiene 02 weeks. Apr 01, 2015 the achilles is the largest tendon in the human body and transmits the powerful contractions of the calf muscles that are required for walking and running.
Nov 03, 2018 the incidence of acute achilles tendon rupture appears to be increasing. It is found at the back of the lower leg, just above the heel bone. The achilles is the largest tendon in the human body and transmits the powerful contractions of the calf muscles that are required for walking and running. Treatment options for an achilles tendon rupture include surgical repair and conservative nonsurgical rehabilitation. The incidence of acute achilles tendon rupture appears to be increasing.
Nonoperative treatment of achilles tendon ruptures phase 1. Torn achilles rehabilitation following surgery and non. Achilles tendon rupture anglesea clinic orthopaedics. If so, you might want to read convincing evidence that you should avoid this ageold practice. Jul 23, 2018 achilles tendon rupture rehab plan duration. Rehabilitation following achilles tendon repair is vital in regaining motion, strength and function. The tendon transmits force from the contracting calf muscles to the calcaneus to cause the foot action of plantar. Find pdfs of our most common rehabilitation protocols. The aim of this study was to summarize various therapies for acute achilles tendon rupture and discuss their relative merits. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Detailed descriptions of the symptoms and how and when the injury occurred. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment nonsurgical or surgical and rehabilitation. Here are guidelines that will help you in preparing for surgery to repair your achilles tendon.
Achilles tendon repair postop protocol penrose physical. Rehab practice guidelines for achilles tendon repair. The surgically repaired achilles will typically be removed from a cast and switched to a. Nonoperative treatment of achilles tendon ruptures phase. Com achilles tendon rupture nonop rehab protocol j bone joint surg am willits et al.
Most patients who sustain an achilles tendon rupture report a pop and a feeling. Achilles tendon rupture nonsurgical and surgical protocol. Rehabilitation protocol for achilles tendon repair this protocol is intended to guide clinicians and patients through the postoperative course for an achilles tendon repair. Jul 05, 2019 surgical approach to torn achilles rehabiltiation. Achilles repair rehabilitation protocol key considerations. Achilles tendon rupture nonop rehab protocol j bone joint surg am willits et al. Rehabilitation protocol achilles tendon repair alterg. Modifications to this guideline may be necessary dependent on physician. This means that the pain settles during exercise but after resting it may then increase. As such, it should be stressed that this is only a protocol and should not be a substitute. Dependent upon the patient and quality of the repair, weight bearing status postoperatively as well as the intensity and time frame of initiation of functional activities will vary. Rehabilitation protocol general principles this protocol for achilles tendon repair is designed to provide the rehabilitation professional with a general guideline for patient care with the alterg antigravity treadmill.
Sports medicine physical therapy rehabilitation protocols. Table e1 achilles tendon rupture rehabilitation protocol time frame activity 02 weeks posterior slabsplint. Your surgeon and you will determine what is best for you by discussing your specific injury and goals. The diagnosis of an achilles tendon rupture is made from clinical history, physical exam and diagnostic testing. Stair climbing machine light workout maintain dorsiflexion at neutral. Initially a walking boot is used for the first 45 weeks. Achilles tendon rupture nonoperative rehab protocol prescription. Together, these five muscles and their respective tendons constitute the plantar flexor muscletendon complex. Nonoperave dynamic treatment of acute achilles tendon rupture. Postop days 1 10 bracesplint watch for skin breakdown crutches non weight bearing nwb active motion arom hip and knee wiggle toes straight leg raise slr x 4 lower extremity le stretches hamstring, quads, itb, hip flexors ice. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making.
We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Calf girth, plantar flexor strength and ankle rom are all keys to full recovery. Your achilles tendon is the biggest and strongest tendon in the body. Achilles tendon repair postop rehabilitation protocol. Rehabilitation guidelines for achilles tendon repair. Activities such as walking, running or jumping places stress on the tendon which can lead to over use, inflammation and small tears. It is hypothesized that this lack of consensus and guidelines leads to suboptimal recovery and higher societal costs. It can occur at any age but is most common between the ages of 30 and 50. For best outcomes, the achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. Achilles tendon rupture repair return to sport protocol keys for achilles tendon rehabilitation. Most patients who sustain an achilles tendon rupture report a pop and a. Achilles tendinopathy can be described as an insertional or midportion, the difference.
Mar 15, 2016 this protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Sep 20, 2017 do you always position your patients ankle in full equinus after an achilles tendon rupture. If it does, rest the patient until pain level is clearly decreasing. Torn achilles rehabilitation following surgery and non surgical. Plaster castrigid boot with foot pointing downwards 20 with 3 wedges inside 221610, more if needed. There may be a tender lump andor audible clicking from the tendon when you move your ankle. As tolerated in cam walker boot with heel wedges in place first wedge removed at 4 weeks, second wedge removed at 6. Often the tendon is very tender to touch when gently squeezed. Table e1 achilles tendon rupture rehabilitation protocol. Magnetic resonance imaging confirmed the presence of a complete rupture of the achilles tendon. Achilles tendon rupture nonoperative rehab protocol.