Achilles Rupture Protocol

Surgery to repair a torn (ruptured) Achilles tendon is conducted on an outpatient basis using a local anesthetic. It involves making an incision or cut in the back of the leg above the heel to access the torn tendon.

The surgery involves suturing the ruptured ends of the tendon back together and applying a splint for a couple of weeks while the tendon heals followed by gradual transition back to weightbearing. Surgery may be delayed for about one week after the rupture to let the swelling go down. If treatment is delayed longer and there is a large gap between tendon ends, additional procedure may be required.

After surgery, we typically follow a modified contemporary protocol (see below reference).  This post operative protocol may be modified on an individual patient basis.

 

 

Achilles Tendon Rupture Protocol

Time Frame

Activity

0-2 Weeks

Splint, non-weight-bearing with crutches

 

Ice and elevate to control swelling

2-4 Weeks

CAM boot with heel lift (2cm)

 

Protected weight-bearing with crutches

 

Ice and elevate to control swelling

 

Hip/knee exercises with no ankle involvement

4-6 Weeks

Weight-bearing as tolerated

 

Continue 2-4 week protocol

 

Active ankle range of motion to neutral

6-8 Weeks

Remove heel lift, remain in CAM boot

 

Weight-bearing as tolerated

 

Begin physical therapy

 

Scar massage

8-12 Weeks

Wean off boot

 

Continue physical therapy

 

*Patients required to wear boot while sleeping, remove only for showering with caution.

 

Adapted from:

Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean and Alexandra Kirkley Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation. J Bone Joint Surg 92: 2767-75, 2010.

 

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