Monday, January 14, 2008

Pop quiz, hotshot. What do you do?

Here is a general crash course of what you’re in for.

General Considerations:
- Time frames mentioned in this protocol should be considered approximate with actual progression based upon clinical presentation. Physician appointments as well as continued assessment by the treating practitioner should dictate progress.
- Avoid forceful active and passive range of motion of the Achilles for 10 - 12 weeks.
- Carefully monitor the tendon and incisions for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization and friction massage) to decrease fibrosis.
- All exercises should be carefully observed for any signs of compensation or guarding.
- No running, jumping, or ballistic activities for 6 months.
- Aerobic and general conditioning throughout the rehabilitation process.
- M.D. appointments at Day 1, Day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-op.

0 - 3 weeks:
- Adjustable boot locked out at 30 of plantar flexion.
- Non-weightbearing for 3 weeks--no push off or toe-touch walking.
- Pain and edema control (i.e. cryotherapy, electric stim, soft tissue treatments).
- Toe curls, toe spreads, gentle foot movement in boot, straight leg raises, knee flexion/extension.
- Well-leg cycling, weight training, and swimming for cardiovascular conditioning.

3 - 8 weeks:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated. After 6 weeks, okay to progress to full weightbearing.
- Walking orthosis adjusted 5 degrees a week until 10 degrees of plantar flexion. After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4 " heel lift in shoes).
- Isometrics of uninvolved muscles, light active dorsiflexion of the ankle until gentle stretch of Achilles. Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot.
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks.
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only. Deep water workouts.
- Soft tissue treatments daily.

8 - 12 weeks:
- Full weightbearing with heel lift as tolerated, gait training.
- Wean into a regular shoe over a 2-4 week period.
- Begin and gradually increase active / resistive exercises of the Achilles (i.e. submaximal isometrics, cautious isotonics, Theraband)
- Manual full passive range of motion of the Achilles--nothing forceful.
- Progress to cycling in shoe, swimming.

3 - 6 months:
- Wean off heel lifts (if not already).
- Closed chain exercises: controlled squats, lunges, bilateral calf raise (progress to unilateral), toe raises, controlled slow eccentrics vs. body weight.
- Cycling, VersaClimber, rowing machine, Nordic Track (gradually).
- Unless excessive fibrosis present, should be discharged into a home program.

6 months - 9 months:
- Progress training jogging / running, jumping and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises.
- Return to physically demanding sport and/or work.


Anonymous said...

I realize this is over a year after your post, but hopefully you are monitoring.

I have had a series of small "pops" in my achilles about 5 inches up from the bottom of my heel. Very slight aching feeling too. All of them occured while flexing/stretching my calf muscle. I first noticed stepping out of the shower out and over the edge of the tub. It felt like something fell and hit the back of my leg. All of the others happened while walking up stairs. I play adult softball (i'm 43 years old) and haven't had any problems with this while playing. It has only occured over the past 2 days. I don't play for a week, but I am very worried about what is going to happen when I have to make a sudden running start.

My question is, did you have any warning signs before the rupture or did it just happen suddenly without warning? If you could copy your response to my e-mail, I would appreciate it.


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Cathy Davis said...

Quite informative blog.

Cathy Davis said...

Quite informative blog.

Anonymous said...

I am 65 years old and stepped into a 2 foot drainage ditch Jan 27, 2010, heard a "pop", and felt like I broke my leg. Hobbled into my car and iced my achilles tendon and calf. It is now July 9, 2010, and I havent seen a doctor. I have been limping, and the good leg is suffering from taking the weight off the damaged one. I knew it was the achilles because when lifting my big toe there was barely any movement in the achilles tendon. What seems to be good news is within the last few weeks I found that I can lift my heel and stsand on my toes on the damaged leg when chest deep in water. I have been doing heel lifts 3 times a week, and have decreased my bouyancy by doing the heel lifts in shallower water, now up to my waist. The improvement has been dramatic. I appears that the rupture was severe, but partial. The numbness, and strange feeling is going away, and my stride is almost normal. I regret that I didnt seek immediate medical attention. I was in denial of the potential risk of nevere recovering. And to make it worse I am a Type 2 diabetic, and feared the consequences of surgical complicatons leading to amputation. It is still too soon to know how much healing lies ahead, but I am feeling good about being able to get up on my toes with one foot tht seemed hopless. I will know I am OK when I can do a heel lift on dry land. Itg seems that may be possible in a month or two if I continue the water therapy/exercises.