Partial or Complete 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, also known as the heel cord, connects the large calf muscles (Gasctrocnemius 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

  • "Pop" or rip heard or felt at the back of the heel at the time of injury.

  • Pain and weakness when moving the foot (especially when pushing down with the front of the foot). If you have ruptured the tendon completely, you will not be able to rise on your toes on the injured leg. The pain can sometimes be severe. With a partial rupture, you may still be able to move your foot, and you may experience only minor pain and swelling.

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

  • Bruising at the Achilles tendon and heel after 48 hours.

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 (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:

  • Sports that require sudden, explosive muscle contraction, such as those involving jumping and quick starts, and running or contact sports.

  • Poor strength and flexibility.

  • Previous Achilles tendon injury.

  • Untreated Achilles tendinitis.

  • Corticosteroid injection into the Achilles tendon.

  • Medical conditions, such as decreased circulation due to any cardiovascular medical problem or obesity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate rest and recovery between activities.

  • Maintain physical fitness:

  • Ankle and leg flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Taping, protective strapping, or an adhesive bandage may be recommended before practice or competition.

PROGNOSIS

If treated properly Achilles tendon ruptures are usually curable in 4 to 9 months.

RELATED COMPLICATIONS

  • Weakness of the calf muscles can occur, especially if the rupture goes untreated.

  • Repeat rupture of the tendon is possible even after treatment.

  • Prolonged disability can occur.

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

TREATMENT

  • Initial treatment involves removing all weight from the affected leg. Ice, medication, compression bandages, and elevation of the leg may be used to help reduce pain and inflammation.

  • Definitive treatment options include : surgical for complete tears and nonsurgical treatment for a partial tear. The return to sports is usually about the same with either treatment course but can occur a few weeks sooner with surgery.

  • Nonsurgical treatment can be used only for a partial rupture of the tendon. The affected leg is placed in a long cast (from foot to groin) to immobilize the injured tendon and allow for healing. The leg is kept in a cast for 4 to 9 weeks followed by immobilization in a walking boot for an additional 4 to 12 weeks. After immobilization, strengthening and stretching exercises are recommended to regain strength and a full range of motion. Nonsurgical treatment does not involve the risks associated with surgery (infection, bleeding, or nerve injury). However, the recovery period is usually longer than with surgical intervention, and there is a higher risk of repeat rupture of the tendon.

  • Medication

  • If pain medication is necessary, 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 for 7 days before surgery.

  • Prescription pain relievers may be given by a caregiver. Use only as directed and only as much as you need.

  • Surgical treatment is performed to reattach the tendon to the heel bone (calcaneus) with sutures. After surgery, the lower leg and foot are immobilized in a cast. After immobilization, strengthening and stretching exercises are recommended to regain strength and a full range of motion. The advantages of surgical intervention are shorter recovery, no need to immobilize the knee, lower risk of repeat rupture, and a stronger calf muscle after injury. The disadvantages include the risks of surgery, such as impaired wound healing, nerve injury, and infection.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain increases, despite treatment.

  • Cast discomfort develops.

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects).

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 __________ 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 your right / left foot under your 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 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 (table, 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 right / left knee.