Conservative Management In Achilles Rupture
The management of achilles tendon ruptures and the achilles tendon rupture rehabilitation process is handled either surgically, or conservatively (non-surgically). The goal of either approach is to facilitate healing and ultimately restore function as much as possible returning the patient to their pre-injury activity levels. With a conservative non-operative approach the idea is that through the use of casting or bracing methods such as a “moon” boot the ends of the ruptured tendon are approximated and held as such for an extended period in an attempt to maintain contact between the ends to aid healing. The exact approach taken varies from specialist to specialist but generally the foot is initially placed in full plantarflexion (toe pointing position) and then over a period of weeks the foot is gradually progressed into a neutral position with any weight bearing allowances progressively increased over the same period. Ultimately the boot, or casting is then removed at around the 8-12 week mark (again dependent on the specialist and individual circumstances).
Physiotherapy And Achilles Tendon Rupture Rehabilitation
Traditional verses an accelerated functional rehabilitation approach. Protocols which promote early weight bearing and mobilisation are gaining momentum in recent years in both the surgical and non-surgical situations. Yet there is no consensus with foot and ankle specialists regarding the most preferable protocol and approach to Achilles tendon rupture rehabilitation and again which path is taken tends to again be dependent on the consulting specialist and individual circumstances.
Also the physiotherapy rehab approach once cleared to start moving and loading the area following the period of immobilisation depends on the initial management chosen (be it surgical or conservative) and individual circumstances. A basic guideline for a physio rehab approach will see the physiotherapist focus on:
- Improving range of movement at the ankle
- Normalising gait
- Increasing the muscle strength and firing
Achieving these things and ultimately a return to sports somewhere around the 6-12 months mark after injury depending on individual circumstances, which protocol is followed and individual sporting demands.
Variations In Return To Play Time Frames
With Achilles tendon rupture rehabilitation protocols are followed to ensure that there isn’t a situation of overloading the tendon too early and depending on the surgeons view regarding the use of a traditional verses accelerated functional rehabilitation approach the time frames for return to play will vary. But I tend to find even working within the guidelines often the outcome is quite dependent on the motivation of the patient to work to restore ROM and strength and restore their function as much as the restrictions within the protocol itself. In my Sydney physiotherapy practice I frequently see quite a variety in return to play time frames for my patients following Achilles tendon ruptures and reiterate that often I feel that has a lot to do with the individuals motivation to return to play and their level of commitment to their Achilles tendon rupture rehabilitation, with generally the committed individuals being ready to go once the protocol allows having achieved appropriate strength and mobility to allow a return to play. Verses patients less committed to the protocol and their “homework” lagging behind and at the indicated return to play point and having a delayed resumption of full activity levels.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Achilles Tendon Rupture Rehabilitation should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.