Achilles tendon rupture – the right follow-up treatment

The Achilles tendon is located on the back of the heel. It connects the heel bone with the muscles of the calf. If it tears, the affected person is no longer able to stand on tiptoe and has a flat-footed gait.

The Achilles tendon can tear if too much force is applied from outside. For the affected person, this is associated with great pain and immobilization of the foot in a splint for 6-8 weeks, since the foot must not be loaded at first. The follow-up treatment of an Achilles tendon rupture is particularly important in order to restore mobility and muscle strength.

The earlier the injury is treated, the better the chances of recovery. Rehabilitation can be actively started both during surgery and after conservative treatment immediately after the splint is removed. The treating therapist will draw up an individual rehabilitation plan in consultation with the patient and doctor in order to make the foot mobile and resilient again as quickly as possible. The resumption of sports activities is usually only possible without restrictions after 4-12 months.

How is an Achilles tendon rupture conservatively treated?

Conservative treatment for an Achilles tendon rupture is possible if it is not a complete rupture of the tendon. If ultrasound can show that the two ends of the tendon are close together and there is no risk of them growing together, surgery can be avoided. The affected person must then first immobilize the foot in the pointed foot position and is given a special splint for this purpose. The angle is reduced from week to week so that after the splint is removed, the foot is already in its normal position after about 6-8 weeks. Intensive and regular physiotherapeutic care is necessary to optimally advance the healing process.

Physiotherapy after an Achilles tendon rupture

Physiotherapy is particularly important after an Achilles tendon rupture in order to rebuild the Achilles tendon and the muscles that have been extremely weakened by wearing the splint for so long. Therapy is also started while the splint is still being worn, using lymph drainage and light muscle strengthening exercises. The wedge heel in the splint, which keeps the foot in the pointed foot position after the operation, is adjusted week after week at a lower angle so that the foot gradually returns to its normal position.

If a patient comes to the physiotherapeutic facility with a diagnosis of Achilles tendon rupture, this is usually about one week after the operation or injury. The foot is still in the special splint and must not be loaded. For the physiotherapist, this means that passive therapy must be initiated first.

Lymph drainage and other massage techniques are used to combat the swelling and pain. Also a gait training and measures to avoid sticking to the tendon as well as electrical muscle stimulation and cold therapy are on the program. If the patient is allowed to remove the splint after 6-8 weeks, the therapist usually starts with passive exercises to make the immobile Achilles tendon mobile again after the long period of rest.

The physiotherapist moves the patient’s foot passively, i.e. without the patient himself helping with the movement. Many of the movements must first be relearned, since the long resting phase means that the movement sequences can no longer be performed smoothly. Gradually, the patient is then encouraged to actively participate in the movement sequences.

Initially, this means just getting up and putting full weight on the leg. Many independently controlled movements have to be relearned with the help of the therapist, so this part of the rehabilitation program starts with gait and standing training, whereby the patient performs simple exercises under the guidance of the therapist. Also very gentle sports like swimming or aqua jogging can be included in the training plan.

Through special exercises the ankle is mobilized again and the lost musculature is rebuilt step by step. Stretching exercises of the Achilles tendon are also part of the program to get the Achilles tendon flexible and supple. After approx.

12 weeks, under the supervision of the phyisiotherapist, you can start running again with light running training (initially without incline), cycling is also allowed. A heel elevation on both sides is still worn at this time in order not to overload the healing tendon, these are only removed after about 6 months.As a rule, most patients are able to resume full participation in contactless sports after 6 months, and after 9 months these sports are usually also possible again without restrictions. If the patient is allowed to remove the splint after 6-8 weeks, the therapist usually starts with passive exercises to make the immobile Achilles tendon mobile again after the long period of rest.

The physiotherapist moves the patient’s foot passively, i.e. without the patient himself helping with the movement. Many of the movements must first be relearned, since the long resting phase means that the movement sequences can no longer be performed smoothly. Gradually, the patient is then encouraged to actively participate in the movement sequences.

Initially, this means just getting up and putting full weight on the leg. Many independently controlled movements have to be relearned with the help of the therapist, so this part of the rehabilitation program starts with gait and standing training, whereby the patient performs simple exercises under the guidance of the therapist. Also very gentle sports like swimming or aqua jogging can be included in the training plan.

Through special exercises the ankle is mobilized again and the lost musculature is rebuilt step by step. Stretching exercises of the Achilles tendon are also part of the program to get the Achilles tendon flexible and supple. After approx.

12 weeks, under the supervision of the phyisiotherapist, you can start running again with light running training (initially without incline), cycling is also allowed. A heel elevation on both sides is still worn at this time in order not to overload the healing tendon, these are only removed after about 6 months. As a rule, most patients are able to resume contactless sports fully after 6 months, after 9 months these are also usually possible again without restrictions.