Achilles Tendon Rupture 

Mechanism of injury 

• It is a common soft tissue injury most commonly occurring in men than women who participate in frequent exercise or athletic activities 
• It is normally associated with a forceful lengthening and contraction of the muscles of the lower leg during sudden acceleration, deceleration, or jumping/landing 
• Degeneration and mechanical factors increase risk of acute rupture which also includes decreased strength or flexibility of the plantar flexors, excessive body weight, pre-existing tendonitis, and decreased vascularity

A Ruptured Tendon 

• It normally ruptures closer to the heel bone (calcaneus)
• A complete rupture leads to pain, swelling, palpable defect and significant weakness in the plantar flexors 
• Management
  • Extended cast immobilization 
  • Functional bracing 
  • Surgically managed 

Repairment Procedures 

• Primary Repair
  • This is done within a few days to a week after the injury occurred with a direct, end-to-end repair in which the ends of the tendon are unopposed and sutured together
  • Delayed repair of a chronic rupture would require reconstruction of the tendon by autograft or allograft 

Post-Operative Management 

• Conventional Approach
  • 6-week immobilization with the ankle in plantar flexion or for a brief period of time
  • The patient will not weight bear on the affected ankle 
  • Week by Week Post Op Management
    • Week 0-4
      • Below knee cast applied foot in plantar flexion 
      • At 2-3 weeks new cast is applied 
    • Week 4
      • Walking cast will be applied with the ankle positioned neutral 
      • Weight bearing can be initiated
    • Week 6-8
      • Active Range of Motion is initiated 
      • Full Weight bearing with functional brace can begin wearing shoes 
    • Beyond Week 12
      • Functional brace is discontinued 
      • Full weight bearing in shoes 
• Early Remobilization Approach
  • “Functional Rehabilitation” option after primary repair after acute rupture not one that was delayed 
  • Once in the clinic for rehabilitation if the physiotherapist was informed about the type of surgery that was completed early active ROM and weight bearing exercises can be done at an earlier time 

Exercise 

• Protection Phase
  • Maintain ROM of non immobilized joints 
  • Prevent reflex inhibition of immobilized joints 
  • Prevention of joint stiffness and adhesions 
  • Maintain cardiorespiratory fitness 
  • Increase ROM of Operated Ankle