| IMPORTANT: This is a general guideline and may need to be tailored to specific patient needs and conditions. We strongly recommend that all rehabilitation exercises be started under the supervision of a physical therapist with experience treating patients with a ruptured Achilles tendon. |
| Timeframe: 0 to 2 weeks post-injury |
- Wear posterior splint in plantarflexion; non-weightbearing with crutches.
- Elevate injured leg above heart level as much as possible.
- Use oral analgesics (eg, ibuprofen) as indicated.
- Methods to decrease swelling include:
- Ice applied directly to injured area.
- Compression sleeve.
- Ice/compression devices (eg, Normatec, Gameready): Include a boot and ice water cooler. A small pump circulates ice water while providing intermittent compression. Use intermittently throughout the day for 30 minutes at a time as needed based on swelling.
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| Timeframe: 3 to 5 weeks post-injury |
- Wear walking boot with 20 degrees plantarflexion heel lift (3 wedges).
- Protected weightbearing progression with crutches:
- Begin 25% weightbearing with crutches for first week.
- Progress by adding approximately 25% additional body weight each week (ie, second week 50% weightbearing, third week 75% weightbearing) until full weightbearing.
- May remove boot while in seated position with lower extremity hanging free off table/chair/bed to perform motion exercises.
- Perform active ankle dorsiflexion only to neutral at most (ie, ankle not to exceed 90 degrees), followed by passive, gravity-assisted plantarflexion only. Dorsiflex only as far as is comfortable; do not exceed neutral ankle dorsiflexion for 12 weeks. Perform exercise for 5 minutes every hour while awake.
- May perform knee and hip exercises with no ankle involvement (eg, leg lifts from sitting, prone, or side-lying position).
- May perform non-weightbearing cardiovascular exercise (eg, stationary cycling with one leg, deep-water "running" with floats [foot does not touch pool bottom]).
- May use hydrotherapy (with motion and weightbearing limitations as above).
|
| Timeframe: 6 to 8 weeks post-injury |
- Weightbearing as tolerated.* Wear boot at all times while ambulating.
- Ambulate with support device (eg, walker, crutches, rollabout) in hand at all times for safety.
- After 4 weeks of weightbearing in boot, remove 1 wedge from heel lift each week.
- Monitor for swelling; use methods for swelling and pain control listed above.
- Wear controlled ankle motion boot or splint while sleeping until 8 weeks post-injury.
- Begin physical therapy. Therapist should not begin passive dorsiflexion (movement of foot towards the head); this can overstretch the tendon.
- Continue to perform active dorsiflexion exercises with goal of obtaining neutral ankle (ie, 90 degrees) but no further. No passive stretching into dorsiflexion until 8 weeks post-injury.
- Patient may ride stationary cycle only while wearing boot or ankle brace, and only using light resistance, for 10 to 20 minutes.
|
| Timeframe: 9 to 11 weeks post-injury |
- Remove heel lift.
- Weightbearing as tolerated.*
- Slow, gentle dorsiflexion stretching permitted.
- Graduated resistance exercises permitted (open and closed kinetic chain, as well as some functional activities). Introduce exercises gradually.
- May begin proprioceptive and gait retraining.
- May apply ice and heat for comfort.
- May use hydrotherapy.
|
| Timeframe: 12 to 14 weeks post-injury |
- Wean from boot to shoes with gel heel lift.
- Gradually transition to regular shoe wear, initially around the house only, then for outside activities.
- Use crutches and/or cane as necessary with goal of gradually weaning off.
- Gradually advance range of motion, strength, and proprioception exercises.
- When able to perform toe raises with the injured leg unsupported, may begin more challenging strength and proprioception exercises.
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| Timeframe: After 14 weeks post-injury |
- Continue to advance range of motion, strength, and proprioception exercises.
- May begin power and endurance exercise.
- May begin sport-specific retraining.
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