The Achilles tendon or the heel cord is the strongest and thickest tendon in the body. It connects the calf muscles to the calcaneus (heel bone).
The Achilles tendon is extremely important in normal walking therefore its repair must be meticulous to facilitate adequate healing.
In this article, we shall talk briefly about the physiotherapy routine you will follow after undergoing surgery to your Achilles tendon.
Key points;
Foot position after surgery -For the first 4 to 6weeks after surgery, your foot will be kept in slight plantarflexion position (foot pointing down). This could be in either a cast or a boot.
This position allows the tendon to heal without much strain on it as is the case in dorsiflexion (foot pointing up)
Foot repositioning -As the weeks go on, your surgeon or therapist will gradually start to reduce the amount of plantar flexion depending on your level of comfort.
Walking after surgery – As far as walking is concerned, you are allowed to walk around with the aid of axillary crutches without bearing weight on the repaired foot.
Sleeping time – You will have to sleep with the boot or cast on to maintain the desirable positions/angles of the foot.
Exercises -High-impact exercises that involve jumping are not allowed until 6months after the repair.
Caution– these exercises should not be followed as a strict guideline as recovery varies from one person to another.
Rehabilitation of Achilles tendon guided by weeks
Week 0 to 4
Goal;
The goal here is to have a complication-free wound healing.
- Wound care;
Your surgeon or nurse will attend to your wound, assess for signs of abnormal discharge, infection, and edema and change the dressing as required.
You are not supposed to open or directly touch your surgical wound and if you notice any abnormal symptoms, then immediately book an appointment with your surgeon to evaluate your symptoms.
Your foot will be in a boot that will be locked in about 30 degrees of plantar flexion.
Weight bearing status
-You are not allowed to walk on that leg yet.
Exercises to do
For lower limb
-Toe curls; These facilitate blood flow through the foot. Do as many as you can tolerate.
-Knee Rom exercises. This prevents stiffness at the knee joint.
Week 4 to 6
Goal;
The goal here is to start partial weight bearing with acceptable range of motion
At this stage, the boot still is locked in 30 degrees of plantarflexion. This could be reduced by 10 degrees each week
Weight-bearing status
You can start partial weight bearing, still keeping on the boot.
Exercises
Active range of motion exercises are those done by the patient without any assistance while for passive range of motion exercises, someone will assist you to move a certain body part or joint.
- Active Dorsiflexion exercises; gently move the foot to face upwards until is comfortable.
The goal is to have the foot at neutral (normal foot position) by 6 weeks.
With the boot on; do passive eversion and inversion exercises.
- Inversion; move the foot slightly so that the sole of the foot faces inwards
- Eversion; move the foot so that the sole of the foot faces outwards.
Continue with knee and hip range of motion.
For cardiovascular conditioning, use an ergometer which is basically like a stationary bike for your arms.
Week 6 to 8
Goal;
The goal here is to start full weight bearing
You can start full weight bearing as tolerated while still wearing the boot.
At 8 weeks, you will slowly start to transition back to your dress shoes with a heel insert.
Weight bearing status
Full weight bearing; putting full weight through your whole foot.
Exercises;
Range of motion (ROM) exercises
- Full passive ROM; eversion/inversion. Plantar flexion and dorsiflexion.
- Active ROM; Neutral active dorsiflexion. This means that you shouldn’t move your foot to face upwards.
- Strengthening exercises;
Sit on a chair and do some heel raises.
How to;
With your toes on the ground, raise your heels; do 10 repetitions 3 times.
- Gait exercises
By 8 weeks, you should be able to walk without any sort of compensation.
Refrain from dragging the operated leg.
Week 8 to 14
This is a time in which most tendon re-ruptures occur.
Goal;
The goal here is to achieve a full active range of motion in all directions.
What to avoid;
Running and high-contact activities
Exercises
- Continue with seated heel raises.
- Standing leg raises.
How to;
Stand next to a wall or rail for support and raise onto your toes, off your heels. Hold for 5 seconds and then get back down. Do 10 repetitions 5 times.
Repeat this about as many times as you can over the course of the day.
In conclusion, an Achilles tendon injury is a pretty debilitating one. After orthopaedic treatment for this injury, you will start off with immobilization for about 4 to 6 weeks.
After that, exercises will start which will range from a range of motion exercises (no pun intended) to strengthening exercises for your lower limbs.
