Achilles Tendon Repairs and Rehabilitation

The Achilles tendon is the strongest tendon in the lower limb and provides a huge amount of power for running, jumping and changing direction. Achilles ruptures are a common traumatic injury in running, acceleration-based sports including athletics, rugby, AFL and netball. The Achilles ruptures with a sudden push off mechanism when sprinting or changing direction. Patients often describe a feeling of sudden pain and being kicked in the back of the leg or calf, only to see no one is behind them. This is a cardinal sign of an Achilles rupture.

Achilles ruptures can be managed surgically or non-surgically. This decision is based on any medical history and other medical conditions, age, location of the tear and the goals of the injured person or athlete.

For younger, athletic patients with goals of returning to their sport, surgery is the most common method of management as it promotes a quicker return to play. After surgery to repair the torn tendon, patients are placed in a cast for 2 weeks, followed by a CAMboot (moonboot) for a period of 6-8 weeks with a series of heel wedges to reduce the stretch on the Achilles and allow it to heal in a shortened position. Weight bearing is gradually increased over this time. If the Achilles is allowed to heal in a stretched position, this reduces the tendons’ tensile strength, which increases the risk of re-rupture and will result in reduced calf power in the long-term. This is why Achilles surgery needs to be done as soon as possible after injury to result in the best outcome.

For older patients (40-50+), those with other medical conditions (such as diabetes) or those who have no goals of returning to sport, non-surgical management may be an option. This is best to be discussed with an orthopaedic specialist before following this management pathway. The patient is placed in a CAMboot immediately after injury with multiple heel wedges to shorten the Achilles and promote better healing. This is progressively weaned (reduced), generally over a 2-3 month period (dependent on your surgeons advice and protocol).

After this period, a 6-9 month rehabilitation program is undertaken to restore range of motion, endurance, strength, power, returning to running and finally a return to sport specific activities for athletes. This is best to be undertaken with the guidance of your physio to ensure you rebuild the required strength and power in the Achilles tendon and calf to return to sport.

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