LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Vacoped Rehab Achilles Rupture

Achilles Rupture Rehab times

 

Phase 1 Protection (0-8 weeks)
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 WEEKTREATMENT PROCESS
Week 1 
NWB 
Vacoped fixed on 30 ° with wedged sole. WB as advised Patient in Equinus (30° PF) POP 
Week 2
NWB
Week 3 
WB in Vacoped & Mobilisation 
Vacoped fixed on 30 -25 ° with wedged sole, wear 24hrs.
WBAT 
Physiotherapy to start 
Soft tissue massage 
Passive ROM 
Gentle active 
Starts Quads, Hams and core strengthening 
Week 4  Vacoped fixed 30-20 ° with wedged sole 

Active PF with Theraband 
Seated heel raises  
ROM 0° DF maximum 
Full PF, INV, EV, Proprioception/Balance etc 
Aim for plantigrade by 5-6 weeks 
 

Functional movements (squats, steps) 

Week 5
Early active Rehab and limited
WB
Vacoped fixed 30-15° with wedged sole 
Week 6  Vacoped fixed 30-10° change to flat sole
Week 7  Vacoped fixed 30-5° keep flat sole 
Week 8 Vacoped fixed 30-0° keep flat sole 
Week 9 
WB Rehab progressing through to daily function and NWB sports 
Discard Vacoped change to flat shoe with 1cm heel lift for 4 weeks  
use Vacoped for outdoors 
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 10 Flat shoe with 1cm heel lift. No Vacoped outdoors   
Week 12 Flat shoe with 1cm heel lift  Gentle WB dorsiflexion stretch (Lunge position) 
Plyometrics to start forwards, backwards, directional, change of direction 
Week 13
Progressive exercise
Flat shoe with 1cm heel lift   
Week 14-20 
Progress to Full Sports
Normal shoe with no heel lift 

Red = strictly non weight bearing, Yellow = weight bearing as tolerated (WBAT), Green = fully weight bearing

 

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 

  • Chelsea & Westminster Hospital NHS
  • Fortius Clinic