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Article written by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor
Actualizat: 28-06-2022 / Publicat: 04-07-2017
Achilles tendon suture recovery protocol
The origin of the gastrocnemius muscle is in the upper part of the lateral femoral condyle and on the medial condyle of the femur. The insertion is made with the help of the Achilles tendon on the posteromedial surface of the calcaneus. Its most important roles are plantar flexion and knee flexion.
General principles
Avoid forced, both passive and active mobilization of the Achilles tendon for 10-12 weeks
Carefully monitor the tendon to assess its mobility and the postoperative incision to follow the physiological granulation process. Perform soft tissue treatments (wound mobilization and massage) to prevent local edema and fibrosis.
All exercises should be closely monitored for any signs of compensation
No running exercises or jumping in the first 6 months
Aerobic and general conditioning exercises throughout the recovery process
Causes
Achilles tendon rupture is relatively common in middle-aged athletes and young adults, men, sedentary, who do sports occasionally. Achilles tendon rupture is considered to be the third most common tendon rupture. Mechanism: hyperextension of the forefoot under body weight with the knee in extension, sudden dorsiflexion of the ankle, and violent plantar dorsoflexion (for example: falling from a height).
Achilles tendon ruptures occur in the least vascularized areas (the vascularization of the physiological tendon is quite weak).
Treatment
It has been and still is quite controversial, many authors compare the results obtained with orthopedic treatment with the surgical one. Interestingly, the results obtained with orthopedic treatment are similar to those obtained with surgical treatment, in the case of an incomplete rupture. In the case of surgical treatment, the recurrence rate is much lower. However, surgery is recommended as the main method of treatment.
Rehabilitation protocol
Week 0 - 3
Immobilization in a splint with the foot at 30 degrees plantar flexion
Do not load on the operated limb in the first 3 weeks
Control of local pain and edema (cryotherapy, electrical stimulation, soft tissue treatments)
Manual
Soft tissue mobilization to monitor local edema
Exercises
Active movements of the toes, light movements of the foot in the splint, lifting of the operated limb with the knee in extension, flexion/extension of the knee
Cycling (using only the healthy foot), swimming for cardiovascular exercises
Objectives
Minimizing local pain and edema. Walking with crutches, without stepping on the operated limb
Week 3 - 8
Immobilization in a splint / walking orthosis set at 30 degrees plantar flexion at 3 weeks; adjust 10 degrees each week
Gradually increase the load from the simple touch of the fingers, for balance, to the contact of the heel with the ground (partial load)
At 6 weeks, full loading on the operated leg is allowed
Manual
Soft tissue mobilization to monitor local edema
Initiate passive movements of the foot with dorsiflexion (without exceeding the neutral position), inversion/eversion exercises of the foot depending on the pain tolerance
At 4 weeks, it is allowed to mobilize the post-operative wound, once it has closed completely
Exercises
Exercises for lifting the operated limb, with the knee in extension, abduction exercises for the hip, exercises for extending the torso to the bridge position with the limbs in extension
Isometric exercises of the muscles not involved in the Achilles tendon
Active movements of the foot with dorsiflexion (light stretching of the Achilles tendon is allowed at 4 weeks)
Isometric exercises of the Achilles tendon
Progress the Achilles tendon stretching exercises at 6 weeks
Proprioceptive exercises, intrinsic strengthening of muscles
At 6 weeks, you can ride a bike, pushing the pedal only with the heel
Objectives
Neutral foot position
No crutches and full charging at 6 weeks postoperatively
Week 8 - 12
After 8 weeks, you can wear regular shoes, but that includes plantar lifts.
Full load on the operated limb, walking exercises
Exercises
Start and gradually increase active and resistance exercises of the Achilles tendon (submaximal isometric exercises, isotonic exercises, Theraband exercises)
Cycling, swimming
Objectives
Full range of ankle movement
Tolerance of using ordinary footwear, normal walking, without compensation
Month 3 - 6
Squatting exercises (under the close monitoring of the physical therapist), lifting exercises on the fingertips (bilateral - progressing unilaterally), diving exercises
