Achilles Tendon Repair - Rehabilitation Protocol:
Phase 1- Weeks 1-2:
Physiotherapy goals:
- Maintain independent ambulation
- Pain and oedema control
- Protection of operated foot in a short-leg non-weight-bearing cast in a plantarflexed position
Interventions:
- Patient discharged from hospital in a below-knee plaster of Paris backslab
- Mobilisation with crutches, non-weight-bearing for 2 weeks
- Encouraged to maintain limb elevation for “55 minutes in the hour”
- Attend clinic no later than 2 weeks for removal of sutures and change of cast
Phase 2- Weeks 2-8: Controlled Mobilisation
Physiotherapy goals:
- Protection of healing tissues in a Vacoped boot
- Progressive weight-bearing with the Vacoped locked at 30º plantarflexion
- Complete avoidance of stretching
- Achilles tendon gentle supine active plantarflexion exercises without resistance- "getting the tendon sliding"
- Pain, oedema control and wound management
Precautions:
- No activation against resistance of Achilles tendon until week 8
- No ankle dorsiflexion beyond neutral until 10-12 weeks
- Early referral back to surgeon for wound concerns
Interventions:
- Progressive weight-bearing in the locked Vacoped
- Pain and oedema control with ultrasound/cryotherapy/deep tissue massage
- Activate other muscle groups without stretching the Achilles tendon
- Forefoot intrinsic strengthening
Phase 3- Weeks 8-12: Early Rehabilitation (greatest re-rupture risk)
Physiotherapy goals:
- Progressive ankle movement while walking in the Vacoped
- Normal walking in standard footwear without walking aids after 3 months
Interventions:
- Change Vacoped settings- full weight-bearing:
- Post-op weeks 8-10: Unlocked allowing ankle movement between an arc of 15 and 30º plantarflexion
- Post-op weeks 10-12: Unlocked allowing ankle movement between an arc of 0 and 30º plantarflexion
- Begin resisted active ROM exercises beginning with Theraband plantarflexion exercises progressing to an exercise bike and balance board
- Wean out of the Vacoped indoors from week 12 into a trainer with a heel lift
- Gait training
- Commence double heel raises at 12 weeks, progressing to a single heel raise as appropriate
Phase 4- Months 4-6: Late rehabilitation
Physiotherapy goals:
- Patient to increase level of activity independently
- Avoidance of exercise involving excessive ankle dorsiflexion (soft-ground running/up-hill running)
- Return to contact sport after 6 months if appropriate
Interventions:
- Increase strengthening of all muscle groups against resistance
- Commence jogging and stair climbing
- Proprioceptive drills
- Eccentric loading and gastroc-soleus stretching only after 9-12 months