PHASE I: WEEKS 0-2
- Protect tendon
- Control pain
PRECAUTIONS & MANAGEMENT:
- Plaster cast with ankle plantar-flexed to approx. 20°
- Non-weight-bearing with crutches
PHASE IIA: WEEKS 2-4
- Protect tendon
- Regain ankle range of movement
- Manage swelling
- Avoid moving ankle beyond plantargrade dorsiflexion when performing any exercise.
- Use camboot with a 2-4cm heel lift. Tubigrip to be worn under camboot to help control swelling.
- Protective weight-bearing with crutches and camboot
- Week 2-3: 25% weight-bearing
- Week 3-4 : 50% weight-bearing
- Emphasise patient must use pain as a guideline; if increased pain, decrease activity and/or weight-bearing level.
- Active DF and DR ROM to neutral, inversion/eversion below plantargrade.
- Static calf contraction in camboot.
- Modalities to control swelling.
- Knee/hip exercises with no ankle movement. E.g. Knee extension in sitting, prone hip extension, SLR.
- NWB fitness/cardio E.g. Exercise bike with one leg
PHASE IIB: WEEKS 4-6
- Protect tendon Regain ankle range of movement Progressively increase weight-bearing in camboot
- Continue protective weight-bearing with crutches and camboot:
- Week 4-5: 75% weight-bearing
- Week 5-6 : 100% weight-bearing
Avoid moving ankle beyond plantargrade when performing any exercise, but can do co-contraction exercises and move through range.
E.g. sliding heel along ground, but not past plantargrade dorsiflexion)
- Continue Phase IIA management
- Emphasise patient doing non-weight-bearing cardio activities as tolerated.
PHASE III: WEEKS 6-8
- Protect tendon
- Continue to regain ankle range of movement
- Begin light Achilles lengthening/strengthening
- Avoid moving ankle beyond plantargrade when performing any exercise.
- Weight-bearing as tolerated in camboot.
- Gradually remove heel lift over 2-3/7: E.g. If patient has 2 x 2cm lifts, take one out at a time
- Continue with modalities for swelling as required.
- Active assisted DF stretching to plantargrade - slowly and initially with a belt in sitting , doing knee straight and knee bent.
- Graduated resistance exercises (open and closed kinetic chain as well as functional activities). Start with theraband exercises.
- Gait re-training ( as now 100% WB in camboot).
- Cardio to now include WBAT exercises e.g. bike.
PHASE IV: WEEKS 8-12
- Wean camboot (usually over 2-5 days) – can drive once 100% weightbearing and no camboot.
- Increase anti-gravity calf strength.
- Continue to progress ROM and proprioception exercises.
- Begin pain free gentle stretching into dorsiflexion beyond plantargrade – no forceful stretch.
- Do not allow ankle to go past neutral position during strengthening.
- Wear ankle brace to provide added stability once camboot removed, if required for patient confidence.
- Tendon remains vulnerable to sudden loading of the Achilles (eg tripping etc) so ensure patient is diligent with ADL’s/exercises to avoid re-rupture.
- Wean camboot as above- patient may need to return to crutches/SPS as required during the weaning process.
- Add exercises such as stationary bike, elliptical, walking on treadmill as patient tolerates.
- Add wobble board activities- progress from seated to supported standing to standing as tolerated.
- Add double heel raises and progress to single heel raises when tolerated. Ensure the ankle does not go past plantargrade position into dorsiflexion.
- Continue to progress strength/proprioception/ROM exercises as tolerated.
PHASE V: WEEKS 16+
- Increase dynamic WB exercise, included plyometric training sport specific retraining.
- Can now introduce full range of motion in strengthening i.e. can go into dorsiflexion beyond plantargrade.
- Return to normal sporting activities at 6 months.