Vacoped Rehab Achilles Rupture

Achilles Rupture Rehab times

Phase 1	Protection (0-8 weeks) 0-2 weeks Non-Weight Bearing (NWB) in POP 2-4 weeks Partial Weight Bearing (PWB) in boot up to 50% 5 weeks Full weight bearing (FWB) in boot
Phase 2	Early Mobilisation (6-12 weeks)
Phase 3	Strengthening (12- 20 weeks)
Phase 4	Return to Activity (5-7 months)
Phase 5	Return to play (8-12 months)

TREATMENT WEEK	TREATMENT PROCESS
Week 1 Rest and elevate the limb Reduce Swelling and bruising Non weight bearing (NWB)	Vacoped fixed on 30 ° with wedged sole.	Patient in Equinus (30° PF) POP
Week 2 Rest and elevate the limb Reduce Swelling and bruising NWB	Consider even up shoe raise on the unaffected limb Shower using the waterproof cover	Patient in Equinus (30° PF) POP
Week 3 Partial weight bear (PWB) up to 50% body weight in Vacoped To wear Vacoped 24 hours a day (remove sole overnight must put back on next morning) Avoid any DF stretches Maintain Core and activity of non – affected joints	Vacoped fixed on 30° Wear with wedged sole, wear 24hrs. Physiotherapy to start	Gentle Soft tissue massage (scar, FHL, FDL Tib post tendons) Under careful guidance start gentle active PF and gentle toes range of movement No active or Passive DF above position held in the boot Starts Quads, Hams and core strengthening
Week 4 PWB Avoid any DF stretches Maintain Core and activity of non – affected joints	Vacoped fixed 30 ° with wedged sole	Introduce gentle Passive and Active PF with Theraband Avoid any DF or stretches until out of the boot Increase gentle active exercises in PF position (Seated heel raises, peroneals, toe flexors, invertors of the ankle)
Week 5 Avoid any DF stretches Early active Rehab and limited Fully weight bearing in Vacoped boot (FWB)	Vacoped fixed 30-20° with wedged sole	Continue with above NWB exercises by week 5 start to regain slowly Full PF, INV, EV Aim for plantigrade by 5-6 weeks Consider using Compex or alternative EMS (muscle stimulation)
Week 6 Avoid any DF stretche Sleep can commence without Vacoped boot (usually around week 6) FWB	Vacoped fixed 30-15° with wedged sole
Week 7 Avoid any DF stretches FWB	Vacoped fixed 30-10° change to flat sole
Week 8 Avoid any DF stretches FWB	Vacoped fixed 30-5° with flat sole	By Week 8 Start Proprioception/Balance work Functional movements (squats, steps,)
Week 9 Avoid any DF stretches FWB	Vacoped fixed 30-0° with flat sole	Continue as above exercises
Week 10 FWB in shoe Avoid any DF stretches WB Rehab progressing through to daily function and NWB sports Continue to build strength, balance, proprioception and core	Discard Vacoped change to flat shoe with 1cm heel lift for 4 weeks use Vacoped outdoor	Gait re-education Ecc/Con loading (bilateral to single emphasis on Ecc phase) To start NWB aerobic- e.g. bike (push with heel not toes)
Week 11 FWB in shoe Avoid any DF stretches	flat shoe with 1cm heel lift for 2/4 weeks. No Vacoped outdoors
Week 12 FWB in shoe	flat shoe with 1cm heel lift for 3/4 weeks	Gentle WB dorsiflexion stretch (Lunge position) be over cautious to avoid over stretching this phase of tendon remodelling
Week 13 FWB in shoe Progressive exercise	flat shoe with 1cm heel lift for 4/4 weeks
Week 13-20 FWB no heel lift Progress to Full Sports	WB in shoes without heel lift	Gentle return to Plyometrics to start forwards, backwards, directional, change of direction walking and progress as see fit

Red = strictly non weight bearing (NWB), Yellow = partial weight bearing in Vacoped (PWB), Orange = weight bearing as tolerated in Vacoped (WBAT), Green = fully weight bearing in normal shoe (FWB)

Milestones – Rehab goals

Week 16 onwards to RTS

Normal gait pattern
Improving KTW 80% of other leg
Improving walking exercise tolerance
Single leg stance with good control for >10 seconds
Ankle ROM between 10° DF to 35° PF
Able to complete single leg heel raise
Able to return to running on flat surfaces at 5 months when have 70% strength of unaffected leg
Girth of calf 1/2cm of unaffected leg

Week 20 onwards

Able to single leg calf raise
Able to horizontal single leg hop x 3 with 75% of unaffected leg
Able to vertical single leg hop75% of unaffected leg
Sprint with toe off phase of running gait
Education that it can take up to 1 year to return to normal preinjury level

FAQ Questions

When can I drive?
Manual – When you can do an emergency stop safely no earlier than 8 weeks
Automatic – With left leg week 2

When can I return to work?
Sedentary – 2 weeks WFH and week 4 return to office
Manual labour – 12-16 weeks return to work

When can I cycle outdoors?
16 weeks post op can safely bike outdoors

When can I jog?
20 weeks post op with supervision of this milestone with Physio

When can I swim?
With a Vacoped boot start hydro with supervision of Physio at week 4 onwards
Swim only weeks 16

When can I play tennis?
4-6 months post to discuss milestone with physio

When can I wear normal shoe?
Week 15 onwards

When can I get back on the pitch?
Elite athlete – 6-9 months
Recreational athlete – 9 months

When can I wear high heels?
20 weeks onwards