What therapy is used for a torn Achilles tendon
As already mentioned, a torn Achilles tendon can be treated conservatively or surgically (see Operation Achilles tendon tear). While a surgical therapy is always considered in principle for a competitive athlete, the form of therapy for less athletically ambitious or older patients can be conservative. It should be mentioned, however, that in Central Europe, the Achilles tendon rupture is usually treated surgically, while in the Anglo-American world, conservative therapy is more common.
The therapy of a patient with Achilles tendon rupture is usually individual and can only be made after the diagnosis. First aid should always be given in the form of:. – Interruption of the (sporting) activity.
- Cooling (ice, cool pack, …)
- Compression bandage
- Elevation of the leg
- Transport to the doctor
Within the scope of the diagnosis, the extent of the Achilles tendon tear can be determined by means of ultrasound and X-ray. The ultrasound examination is performed in the pointed foot position. If the doctor determines that the ends of the tear touch when the foot is lowered, the ends of the tendon can heal together.
A surgical therapy of the Achilles tendon tear can then be dispensed with. This can be explained among other things by the extensibility of the tendon. It can – if it seems necessary – be stretched to about twice its size.
Helpful for conservative therapy are also special shoes with a raised heel area and an immobile, firm tongue. Similar to a heel shoe, the foot is lifted into a pointed foot position, allowing the tendon ends to make contact. In most cases, after a phase of partial loading, normal loading can be carried out relatively quickly. Constant checks should be carried out by the treating physician in order to observe the healing process and to optimise it if necessary. Ideally, the conservative therapy of the Achilles tendon rupture can be considered complete after about six to eight weeks.
Of course, the exact duration of therapy depends on the progress of healing of the injury. It is also decisive whether and which surgical procedure was used. In most cases, however, patients should expect a physiotherapy period of at least 12 weeks.
There are two opposing forms in the treatment of an Achilles tendon rupture: 1. immobilisation The injured foot is fixed in a plaster cast, shoe or splint for 4-9 weeks. Loads and movements are not allowed 2. Early functional aftercare The foot may be moved shortly after the operation.
Under physiotherapeutic control, the patient learns to gradually increase the load. Different aids, such as plaster and orthosis, are also used here. To date, studies have not been able to identify any relevant differences in the therapeutic success achieved.
Nevertheless, in many countries there is a tendency towards early functional aftercare! Such a typical course of therapy can look as follows, for example: In the first days after the operation, one speaks of an inflammatory phase. Here, the observation of the beginning healing processes is in the foreground.
At this time, it is not advisable to directly load the Achilles tendon. Instead, patients should move other joints, such as the knee joint. In addition, training can be done with the healthy leg to maintain muscle strength.
During the inflammatory phase, the affected foot should be elevated. Now follows the so-called proliferation phase, in which the patient wears an Achilles tendon relief shoe (orthosis) day and night. Under specific physiotherapeutic guidance, exercises are used to promote mobility and coordination.
At this time, no strength exercises may be performed because the tensile strength of the Achilles tendon has not yet been restored. Basically, therapy at this time is only allowed in the pain-free area. In the so-called remodeling phase, the affected person begins from the 8th week carefully with the strength building of the shrunken calf muscles.
In addition, mobility is further increased, but always in the knowledge that the tendon has still not reached its complete stability. At the earliest in the 12th week, but often significantly later, jumps may be performed. Often patients start with jumping on the spot and increase the exercises up to deep jumps from e.g. a platform. Based on the ability to jump, the treating orthopaedist and physiotherapist can also determine when it is possible to start doing sports again.