Magnetic resonance imaging confirmed the presence of a complete rupture of the achilles tendon. Most achilles tendon ruptures occur in sports that require running, jumping and change of direction. It can occur at any age but is most common between the ages of 30 and 50. Achilles tendon repair rehabilitation postoperative guideline.
Achilles tendonitis rehabilitation exercises you can do the towel stretch right away, when the towel stretch is too easy, try the standing calf stretch, soleus stretch, and plantar fascia stretch. Brian grawe, md progression is based on healing constraints and functional progression specific to the patient. If it does, rest the patient until pain level is clearly decreasing. Activities such as walking, running or jumping places stress on the tendon which can lead to over use, inflammation and small tears. Although a 6week cast immobilization is common, many early functional. Tendon neuroplastic training uses strengthbased training with external cues as a strategy to optimise neuroplasticity. Manual resistance exercises, but cautious with df resistance. Amol saxena, dpm, facfas debridement of achilles tendon post. The achilles tendon is a strong tendon attaching the two major calf muscles gastrocnemius and soleus to the heel bone calcaneus. 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. Alfredson protocol for achilles tendonitis treatment.
Foot and ankle the treatment of a rupture of the achilles. Amol saxena, dpm, facfas debridement of achilles tendon. The achilles tendon is the thick tendon above the heel that attaches the calf muscles to the heel bone. The tendon transmits force from the contracting calf muscles to. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment nonsurgical or surgical and rehabilitation. Achilles repair rehabilitation protocol key considerations. You may learn more about how the stone clinic repairs achilles tendon ruptures without open surgery in our explanation of achilles tendon injury. Your achilles tendon is the biggest and strongest tendon in the body.
Specific changes in the program will be made by the. The typical age for rupture occurs between 3040 years of age. It attaches your two calf muscles gastrocnemius and soleus to the heel bone calcaneus and helps you go up onto tiptoes. Department of physiotherapy department of sport and. Rehabilitation guidelines for achilles tendon repair. Here are guidelines that will help you in preparing for surgery to repair your achilles tendon. Achilles tendon rupture nonsurgical and surgical protocol. Baumbach, wolf mutschler, hans polzer munich university hospital, department of trauma surgery, ludwigmaximiliansuniversity, nussbaumstr.
It is hypothesized that this lack of consensus and guidelines leads to suboptimal recovery and higher societal costs. Accelerated rehabilitation following achilles tendon repair. Postoperative rehabilitation protocols for achilles tendon. Oct 2012 general the rehab protocol for repaired and nonsurgical repaired achilles tendon ruptures are very similar. If at any time after surgery you notice increasing pain, redness. It uses the concept of eccentric loading of your achilles tendon to improve the tendon s ability to withstand forces and stressors. 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. Achilles tendon repair rehab guidelines brian grawe, md. Achilles tendon repair is performed after injury occurs to the achilles tendon. However, the incidence of achilles tendon rupture has increased over recent years.
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. Achilles tendon rupture atr is a common sports injury, with a rising incidence and significant impairments. 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. Calf girth, plantar flexor strength and ankle rom are all keys to full recovery. Please use extreme caution when using assistive devices such as crutches, walker or rollabout. Massage the tendon with your figers achilles tendonitis. Other treatments can be considered if these treatments fail. 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. The optimal postoperative rehabilitation protocol after surgical repair of an achilles tendon rupture is unknown. It attaches your two calf muscles gastrocnemius and soleus to the heel bone calcaneus and. 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. Avoid all passive motion into df for 1st 6 weeks postop 3.
The tendon transmits force from the contracting calf muscles to the calcaneus to cause the foot action of plantar. Achilles tendon repair rehab protocol below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. Also, heel lift removal is also md dependent and communication with the md should be made to. 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. Achilles tendon rupture non surgical and surgical protocol last modified.
The achilles tendon usually rupt ures without warning. Rom should be measure in both open and closedchain methods. Find pdfs of our most common rehabilitation protocols. Achilles tendon rupture repair return to sport protocol. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row. Achilles tendon repair postop rehabilitation protocol. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. This protocol for achilles tendon repair work is developed to supply the rehab professional with a basic standard for patient care. Patient may not still be in rehab at this point on a regular basis, so home exercises program needs to be demonstrated, and explained in detailed pictures and written. As we lose some flexibility and strength over time, it becomes more difficult for the achilles tendon. Com achilles tendon rupture nonop rehab protocol j bone joint surg am willits et al. Your physiotherapist might recommend for some of the exercises to be done until you.
Phases and time frames are designed to give a general sense of progression. When you no longer have sharp pain in your calf or tendon, start exercises 5, 6, and 7. 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. Week 2 postop splint is removed and removable boot is applied with heel lifts to maintain. As tolerated in cam walker boot with heel wedges in place first wedge removed at 4 weeks, second wedge removed at. Table e1 achilles tendon rupture rehabilitation protocol time frame activity 02 weeks posterior slabsplint.
Achilles tendon rupture conservative treatment protocol. 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. Exercise as treatment the use of exercise as a treatment for achilles tendinopathy involves 2 impor. Achilles tendon rupture nonoperative rehab protocol. Rehabilitation protocol achilles tendon repair alterg.
Much evidence has demonstrated that the achilles tendon represents the most injured tendon of athletes and is the most common target of spontaneous ruptures padanilam 2009. Achilles tendon rupture accelerated functional rehabilitation. Achilles tendon is the biggest and strongest tendon in the body. Nonoperative treatment of achilles tendon ruptures phase. Chief, division of sports medicine associate professor of orthopaedic surgery tel. It is designed for rehabilitation following post operative achilles tendon repair. It is found at the back of the lower leg, just above the heel bone. A proposed returntosport program for patients with. It attaches the calf muscles soleus and gastrocnemius to the heel bone calcaneus. Modifications to this guideline may be necessary dependent on physician. As such, it should be stressed that this is only a protocol and should not be a substitute. The calf muscle is a major muscle we use for running, jumping and climbing. Rehabilitation protocol for achilles tendon repair this protocol is intended to guide clinicians and patients through the postoperative course for an achilles tendon repair. Dec 29, 2019 achilles tendon is the biggest and strongest tendon in the body.
This means that the pain settles during exercise but after resting it may then increase. Soft tissue mobilization to anklefooteffleurage for edema. The ideal is to achieve full symmetry in all 3 areas. Rehabilitation guidelines for achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. Table e1 achilles tendon rupture rehabilitation protocol. Jul 15, 2019 the alfredson protocol is a specialized exercise program for people with achilles tendonitis or tendinopathy. Rerupture of the achilles tendon must be surgically repaired. Specificity of sport or activity each of these phases needs to be followed closely, but modified as necessary in order to meet the needs of each individual patient. Achilles rupture nonop orthopaedic medical group of. Achilles tendon rupture affects about 1 in 15,000 people at any one time, increasing to 1 in 8,000 in competitive athletes. Twin cities orthopedics foot and ankle surgery preop. Peroneal tendon repair south carolina sports medicine. Nonoperative treatment of achilles tendon ruptures phase 1.
Debridement of achilles tendon post operative protocol total 6 weeks of immobilization nonweightbearing x 2 weeks weightbearing in boot x4 weeks until 6wks post surgery first postoperative follow up within 25 days after surgery nonweightbearing in cam boot for 2 weeks may cross train with stationary bike with heel on pedal. Achilles tendon rupture nonoperative rehab protocol prescription. Accelerated rehabilitation following achilles tendon. The surgically repaired achilles will typically be removed from a cast and switched to a. This was shown effective with patellar tendinopathy and further research is required into other tendinopathies. Acute versus chronic, as well as, concomitant procedures, and physiologic age of the patient. Achilles tendon rupture nonop rehab protocol j bone joint surg am willits et al. Rehabilitation guidelines for achilles tendon repair uw health. Often the tendon is very tender to touch when gently squeezed. 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. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. The tendon transmits force from the contracting calf muscles to the calcaneus to cause the foot action of plantar flexion foot pointed down. Manual full passive range of motion of the achilles weeks 812. How to fix forward head posture 3 easy exercises from a chiropractor duration.
Achilles tendon repair rehabilitation postoperative guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. There may be a tender lump andor audible clicking from the tendon when you move your ankle. The sports physical therapy service is an integral part of the sports medicine center and the department of. Department of physiotherapy department of sport and exercise. The following protocol is subdivided into four general phases. Sports medicine physical therapy rehabilitation protocols. The area that the flap was harvested from is then stitched together figure 3. Achilles tendon repair the achilles tendon is the strongest and thickest tendon in the body. Nov 03, 2018 however, the incidence of achilles tendon rupture has increased over recent years. As with any muscle or tendon in the body, the achilles tendon can be torn if there is a high. Postoperative protocol peroneal tendon repair please note these are general guidelines and may change for various reasons on a casebycase basis. Below we outline the steps that we have our patients take to recover from achilles tendon repair surgery. Achilles tendon repair rehabilitation protocol this rehabilitation protocol was developed for patients who have had a repair of an acute achilles tendon rupture. Achilles tendon rupture atr is a common sports injury, with a rising.