Achilles Tendon Rupture

with Phase I Rehab

ExitCare ImageA complete tear in the Achilles tendon is known as an Achilles tendon rupture. The Achilles tendon, which is also known as the heel cord, connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and is essential for proper functioning of the calf muscles. The calf muscles are required for pushing the foot downward and are necessary for walking, running, and jumping.

SYMPTOMS

  • A "pop" or tear may be felt at the time of injury.

  • Pain and weakness during movement, especially when raising the heel.

  • Tenderness, swelling, warmth, and redness around the Achilles tendon.

  • Bruising (contusion) around the back of the ankle after 48 hours.

  • Loss of firmness to the touch over the area of the Achilles tendon that ruptured.

CAUSES

  • Achilles tendon rupture is most commonly caused by a sudden force placed upon the Achilles tendon that is greater than the tendon can withstand (for example jumping, hurdling, or sprinting).

  • Achilles tendon rupture may also occur from direct trauma or injury to the lower leg, foot, or ankle.

RISK INCREASES WITH:

  • Physical activity that involves sudden muscle contraction.

  • Poor strength and flexibility of the lower leg.

  • Previous injury to the tendon.

  • Untreated Achilles tendinitis.

  • Steroid injection into the Achilles tendon.

  • Medical conditions, such as poor circulation due to a cardiovascular condition or obesity.

PREVENTION

  • Include a proper warm-up and stretching routine before physical activity.

  • Allow for rest and recovery between physical activity.

  • Maintain lower leg fitness:

  • Flexibility.

  • Muscle strength.

  • Muscular endurance.

  • Cardiovascular fitness.

  • Mechanical prevention:

  • Taping.

  • Protective strapping.

  • An adhesive bandaging that has been recommended prior to physical activity.

TREATMENT

Initially one should not walk on the affected leg. One should also ice the injured area, apply compression with an elastic bandage, and elevate the injured leg to eye level. Both surgical and nonsurgical interventions exist for definitive treatment. The return to sports is usually about the same with either treatment course but can occur a few weeks sooner with surgery.

  • Nonsurgical treatment typically requires the immobilization in the form of a long leg cast (from toes to groin) for 4 to 9 weeks. The long leg cast is followed by a short leg cast or walking boot for an additional 4 to 12 weeks.

  • Advantages: Non-surgical treatment lacks the risks involved with anesthesia or surgery (such as infection, bleeding, or injury to nerves).

  • Disadvantages: Non-surgical treatment involves a longer period of immobilization. This may result in stiffer ankle and knee joints. Also, the calf muscles are slightly weaker and the risk of repeat rupture is higher.

  • Surgical treatment typically requires sewing the ends of the tendon back together, followed by immobilization (typically a short leg cast or walking boot).

  • Advantages: Surgical treatment does not usually require the immobilization of the knee. Surgery also offers a lower risk of repeat rupture of the tendon and slightly stronger calf muscles.

  • Disadvantages: Surgical treatment does include the risks of anesthesia and surgery. These risks include impaired wound healing and injury to a nerve that provides sensation to the side of the foot.

PROGNOSIS

  • Achilles tendon ruptures are typically curable if treated correctly.

  • A period of 4 to 9 months is typical before a return to sports.

RELATED COMPLICATIONS

  • Calf muscle weakness may occur, especially if the rupture goes untreated.

  • The possibility of repeat rupture exists despite treatment.

  • Prolonged disability can occur.

  • Risks of surgery include infection, bleeding, injury to nerves, and impaired wound healing.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • All medications should be taken under the direction of your caregiver. Contact your caregiver immediately if any bleeding, stomach upset, or signs of allergic reaction occur.

  • Prescription pain medication may be prescribed as necessary by your caregiver. Use only as directed and only as much as you need.

SEEK MEDICAL CARE IF:

  • Pain continues to increase, despite treatment.

  • Cast discomfort develops.

  • New, unexplained symptoms develop.

  • You are experiencing any side effects form the drugs used in treatment.

EXERCISES

PHASE I EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Achilles Tendon Rupture Phase I

These exercises will help you begin to restore your ankle flexibility in the first 2 to 4 weeks after your cast is removed. Your physician, physical therapist, or athletic trainer will progress your exercise once you have demonstrated the sufficient gains in flexibility and strength. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair that is preferably not on a carpeted surface.

  • Place right / left foot under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt/towel.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Achilles Tendon Rupture Phase I

These exercises will help you begin to restore your ankle strength the first 2 to 4 weeks after your cast is removed. Your physician, physical therapist, or athletic trainer will progress your exercise once you have demonstrated the sufficient gains in flexibility and strength. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist, or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Dorsiflexors

  • Secure a rubber exercise band/tubing to a fixed object (for example a table or pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band/tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band/tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add weight to the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band/tubing across your opposite foot, slowly, pull your little toe out and up. Make sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.

ExitCare Image STRENGTH - Plantar Flexors, Seated

  • Sit on a chair that allows your feet to rest flat on the ground. If necessary, sit at the edge of the chair.

  • Keeping your toes firmly on the ground, lift your right / left heel as far as you can without increasing any discomfort in your ankle.

Repeat __________ times. Complete this exercise __________ times a day.

*If instructed by your physician, physical therapist, or athletic trainer, you may add ____________________ of resistance by placing a weighted object on your knee.