Achilles Tendon Rupture – Non-operative treatment rehabilitation guidelines
0-2 WEEKS REST (PHASE 1)
Goals
- Rest, recovery and mobilise non-weight bearing safely on crutches
Immobilisation
- Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed)
- Can carefully shower with waterproof cover over plaster cast/boot
Physiotherapy
- Elevate limb as much as possible
- Wear boot 24 hours a day
- Pain control
- Maintain hip/knee/toe movement
2-4 WEEKS EASY WALKING (PHASE 2)
Goals
- Confidently weight bearing as pain allows using the crutches
- Begin early, supervised, gentle ankle plantarflexion exercises
- Maintain core, upper limb, hip, and knee strength
Immobilisation
- Rigid walking boot with foot pointing downwards with wedges inside boot
- Wear boot 24 hours a day
- Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering
Physiotherapy
- Can weight-bear with crutches as discomfort allows in boot
- Maintain spinal/hip/knee/toe range of movement
- Can remove boot for exercises to gently actively plantarflex foot from position in boot to full range plantarflexion
- Can dorsiflex back to position in the boot but not beyond
- FHL/FDL/Tib Post tendons massage
- Swelling control
4 – 8 WEEKS WALKING (PHASE 3)
Goals
- Progress to fully weight bearing but maintain use of crutches for balance if needed
- Active ankle movement through available range of plantarflexion from position foot held in boot
- Regain full inversion and eversion in available plantarflexion range
- Aim for ankle plantigrade/foot flat by6-8 weeks in boot
Immobilisation
- Rigid walking boot with wedges being removed weekly to plantigrade position
- Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering
Physiotherapy
- Can remove one wedge per week until foot flat in the boot
- Can perform active resisted plantarflexion, eversion and inversion with theraband
- Can actively dorsiflex foot ONLY to position allowed by wedges in boot
- Seated heel raises
- Maintain hip/knee/toe movement
- Exercise bike with boot on
- Gait re-education
- No knee hyperextension to compensate for lack of ankle dorsiflexion
8-12 weeks EASY ACTIVE (PHASE 4)
Goals
- Normal walking
- Aim to remove boot by weaning out by 12 weeks
- Increase ankle and lower limb muscle strength
Immobilisation
- Boot with ankle plantigrade/ foot flat on the ground
- Shower carefully so as not to stumble/forcefully dorsiflex ankle
Physiotherapy
- Strengthening
- Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further.
- Allow dorsiflexion to return naturally
- Continue resisted inversion and eversion through range
- Exercise bike with boot on
- Seated heel raises
- Proprioceptive rehabilitation
- Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves
12-24 weeks ACTIVE (PHASE 5)
Goals
- Mastering proprioceptive control in wearing normal footwear.
- Aim for normal dorsiflexion range
- Jogging, increase exercise intensity, Sports specific drills
Immobilisation
- Normal shoes with good heel support
Physiotherapy – Tailored and monitored by physio
- Theraband exercises
- Full active ankle range of movement with dorsiflexion as tolerated
- Progress muscle strengthening from open chain to closed chain during this period
- Proprioceptive rehabilitation
- Single leg stance, eyes closed, wobble board/ BOSU
- Double heel raise progress to single heel raise
- Concentric/Eccentric
- Gastroc/soleus conditioning
- Single heel raises
- Dorsiflexion equal to contralateral side, no need to push to extreme
- Closed chain
- Trampette jogging, jumps, hops
- Plyometric Squats, Plyometric Lunges
- Hopping, Mini hurdle jumps, Straight line running
- Introduce cutting/side to side/ carioca/ figure of 8 runs
- Acceleration-deceleration running drills
- Sports specific rehabilitation
>24 weeks FULL (PHASE 6)
Goals
- Resumption of normal activity
Immobilisation
Physiotherapy
- Normal activity, explosive actions and return to sport
