Achilles Rupture Management

Life, in general, can be overwhelming at this phase, as you suddenly have to spend most of your time on the couch, unable to carry out your regular activities and duties, while hearing lots of information from different resources.

Goals:

• Protect tissue, control inflammation and swelling by elevation

• Initiate non-weight bearing exercises while in boot/cast

• Surgical: avoid infection and other related side effects

Tips:

• Frequent elevation of the injured limb above heart level

• If you are in a boot, wear it 24/7, you can loosen it while lying down to air it out

• Consider short term use of a knee scooter or iWalk for increased mobility and function (long term use not recommended, as it does not load the tendon at all)

During this phase, your injured foot is kept in a walking boot with the foot pointed down to protect the tendon and keep it short. Evidence supports early weight-bearing (0-4 weeks) and accelerated rehab to be most beneficial for the majority of people.

Goals:

• Start walking in a walking boot using crutches with the goal of full weight-bearing

• Start non-weight bearing cardio and lower body strengthening

Tips:

• Start virtual or in-person physiotherapy within the first few weeks of the injury. We can help answer any questions that you have, and provide guidance surrounding common issues, such as showering, sleeping and care for your walking boot and Achilles tendon

• Consider EVENup shoe leveller for the non-injured leg. It is worth every penny.

Coming out of the boot can be scary but it’s necessary to slowly load the tendon with walking and by progressing the calf strengthening exercises. This is a critical phase for physiotherapy as most re-ruptures happen at this phase. Having a great physio will push you appropriately, be a voice of reason and provide the right dosages for your exercises.

Goals:

• Wean out of the walking boot and normalize walking

• Initiate standing calf raises

• Overcome fear of loading

Tips:

• Strengthening vs. stretching to avoid tendon elongation

• When weaning from the boot, wear running shoes with a heel lift and avoid barefoot walking

• Avoid sudden dorsiflexion movements (stepping back quickly)

During this phase, you have to lay down the strength foundations for the calf and other lower body muscles, so you will be ready to start a return to run program. Day-to-day activities become easier, pain is not a limiting factor, however, continuous progression of the strengthening exercises is necessary to move on to activities involving running and jumping.

Goals:

• Increase calf strength

• Introduce modified plyometrics (exercises that use speed and force)

• Initiate return to run the program

Tips:

• Do not rush the return to running. Some patients are ready after 4-5 months, others need 6-7 months. Your physio should guide you through this process and assess your readiness

• You may be getting bored of calf raises but it’s still important to continue with them in all different forms (knee straight, knee bent, full-range, extra weight, different speed etc.)

Everyone’s journey is unique and will start these exercises at different times. And sometimes there is no need to progress this far, as the goals have been already achieved (e.g., walking, hiking, biking). It is important to know that often the formal rehabilitation ends at this stage, but the calf can continue to get stronger throughout the following years.

Goals:

• Introduction of energy storage & release exercises (agility and plyometrics)

• Return to participation and performance

Tips:

• Adding recovery days to your program to avoid irritating the tendon

• Your physio and counsellor may have to address any fears related to reinjury, returning to sports etc.