The treatment of an Achilles tendon rupture can be performed with or without surgery. In both cases the entire treatment (including rehabilitation) usually takes between 12 and 16 weeks. Once the rehabilitation is complete, an almost complete recovery of the former performance capacity is possible.
For competitive athletes, however, the therapy (especially due to the long period of inactivity) is usually associated with a significant performance break. Just a few years ago it was common practice to immobilize the injury, which had previously been treated mostly by surgery, for several weeks in an orthosis (usually a lower leg cast). Today, there is a tendency instead to start much earlier with a gradually increased load on the tendon, as this results in significantly better regeneration. This results in better wound healing and less long-term damage, such as stiffening of the ankle joint. Patients are therefore able to regain their former performance capacity much faster.
First, the tendon and the ankle joint are stabilized by applying a splint (or by using a special shoe) and brought into a toe position. This splint will play an important role in the rehabilitation process over the next few weeks. Only a few days after the operation, the patient can be discharged from the hospital; rehabilitation is then carried out on an outpatient basis.
Manual scar treatment, lymph drainage by massaging the leg and careful passive movements of the foot by the physiotherapist or a so-called motor splint represent the first stage of rehabilitation. Motorised splints are frames that move the foot automatically and with a predetermined intensity and can thus provide excellent support for the physiotherapist’s work. In addition, electrotherapy can be used to promote the healing process and alleviate pain.
For athletes, there is also a specific training of the leg muscles. In the following weeks, the toe position given by the splint/shoe is gradually reduced until finally a normal position of the foot is reached. Parallel to this, the leg is increasingly loaded during the movement therapy until a full load and loose running training is possible.
This can often be the case after about 4 weeks. After a further 2 – 4 weeks, the splint can then be dispensed with. Forearm supports are still necessary, however.
During this time, training of the leg muscles and coordination skills is of great importance and can significantly accelerate the return to work or sport. Typical exercises at the beginning are for example aqua jogging and later exercise units for general fitness, such as cycling or the upper body ergometer. Coordination training can be achieved by standing under full load, first in a bipedal position and then in a one-legged position. Motorised rails are still used to some extent during this phase. Ideally, the patient can then resume his sports activities from about the 3rd month onwards, even if the former strength of the tendon is often not yet reached again at this point.