The Achilles tendon is the strongest tendon on the human body. If a tear occurs, the strain must have been extremely high or there must have been a previous damage. It comes to a complete tear or an incomplete tear.
It is also decisive whether the tear was at the transition to the muscle tissue or starting from the heel bone. The physiotherapy for Achilles tendon rupture consists first of all of a supporting strength training to be able to completely relieve the foot by means of crutches. Then training is done to maintain the existing musculature as far as possible and only when the doctor has released the load, can strengthening exercises of the calf muscles be started.
Aftercare
An ultrasound shows how large the injury to the Achilles tendon is. Surgical treatment is carried out with a braiding suture. The suture should be performed in the first week after the injury.
In the follow-up treatment, the patient receives a Vacoped shoe (a shoe-like splint). During the first two weeks, the foot is positioned in 40° plantar flexion (term for the movement of the foot in the ankle joint towards the sole of the foot). Decongestant measures should be taken in physiotherapy.
Lymphatic drainage or strokes across the calf can be used for this purpose. Thrombosis prophylaxis is also particularly important. The use of crutches and the Vacoped shoe should also be developed.
In the 3rd and 4th week, the minimum load can be started. Furthermore, the foot remains adjusted in a 15° plantar flexion. Active and passive movement of the upper ankle joint is possible within the permitted range.
If the tendency to swelling continues, decongestant measures can still be used. Careful scar treatment is important when removing the stitches to keep them as supple as possible. Before the 5th-8th week, the foot is placed in the neutral position.
In this phase, the adjustment in dorsal extension (the movement of the foot in the ankle joint towards the back of the foot) is worked out. For this purpose, leg axis training with the aid of a scale is usually used to ensure that the load is not exceeded. Nevertheless, it is important to achieve the final dorsal extension.
Slight transverse stretching by the therapist but also active stretching exercises can be slowly incorporated to improve elasticity. In addition, the improvement of muscle strength should be started carefully. From the 9th week onwards, the orthosis is slowly removed.
In this phase it is particularly important to make an exact gait analysis. The patient is allowed to put full weight on his foot again, but is probably afraid of the entire transfer of force and the complete rolling. This fear must be taken away from him to get a physiological gait pattern. For another 6 months, a heel cushion should be placed in the shoes to avoid pre-stretching the calf muscles.
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