Author: Samuel J Haraldson, MD, Sports Medicine Fellow, Department of Sports Medicine, UT Southwestern/Methodist Charlton Hospital.
Coauthor(s): Barbara J Blasko, MD, Clinical Assistant Professor, Department of Emergency Medicine, University of California at Irvine College of Medicine.
Editors: Michael D Burg, MD, Assistant Clinical Professor, Department of Emergency Medicine, University Medical Center, University of California at San Francisco-Fresno; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Thomas Rebbecchi, MD, FAAEM, Program Director, Assistant Professor, Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey.
Nonsurgical management involves application of a short leg cast to the affected leg, with the foot in a slightly downward flexed position. Maintaining the ankle in this position helps appose the tendons and improves healing. The leg is placed in a cast for six to 10 weeks and no movement of the ankle is allowed. Walking is allowed on the cast after a period of four to six weeks. When the cast is removed, a small heel lift is inserted in the shoe to decrease the stress on the Achilles tendon for an additional two to four weeks. Following this, physical therapy is recommended.
There are three things that need to be kept in mind while rehabilitating a ruptured Achilles: range of motion, functional strength, and sometimes orthotic support. Range of motion is important because it takes into mind the tightness of the repaired tendon. When beginning rehab a patient should perform stretches lightly and increase the intensity as time and pain permits. Putting linear stress on the tendon is important because it stimulates connective tissue repair, which can be achieved while performing the “runners stretch,” (putting your toes a couple inches up the wall while your heel is on the ground). Doing stretches to gain functional strength are also important because it improves healing in the tendon, which will in turn lead to a quicker return to activities. These stretches should be more intense and should involve some sort of weight bearing, which helps reorient and strengthen the collagen fibers in the injured ankle. A popular stretch used for this phase of rehabilitation is the toe raise on an elevated surface. The patient is to push up onto the toes and lower his or her self as far down as possible and repeat several times. The other part of the rehab process is orthotic support. This doesn’t have anything to do with stretching or strengthening the tendon, rather it is in place to keep the patient comfortable. These are custom made inserts that fit into the patients shoe and help with proper pronation of the foot, which is otherwise a problem that can lead to problems with the Achilles. [ citation needed ]