Achilles Tendon Repair

Diagnosis:

Achilles Tendon rupture

Surgery:

Achilles Tendon repair – mini open or open

Post operative orders:

Plaster backslab 2 weeks – this is applied in the OR, is to remain intact and kept clean and dry at all times.
Elevate: as much as possible.
Ice: At least 3 times per day 20 mins on, 20 mins off (ice should not be directly contacting skin or allow plaster to become wet)

Weight bearing Status and Exercises:

NON weight bearing for 2 weeks after surgery
2 week review: may be permitted to commence gradual, progressive weight bearing in boot over the next 2 weeks with 4 boot wedges (2cm heel lift).
Active plantar flexion, inversion and eversion exercises below neutral
4 week review: WB in boot with 3 wedges. Remove 1 wedge per week. Non WB fitness/cardio whilst in boot e.g. stationery bike
6 -8 weeks: Gait retraining. Wean boot, may need brief period of walking aids to assist with weaning. Commence strength training (calf raises) and proprioception.
3 months: Normal shoe wear. Gradually increase walking, light exercise. Sport specific training. Increase dynamic WB exercises. No eccentric loading until 6 months.
There is a risk of re-rupture if you fall or try to accelerate the rehabilitation protocol.
Driving: Casts and boots and strong pain medications can interfere with your ability to drive.
You must be able to safely operate the vehicle including the accelerator, brake and clutch pedals at all times and respond in the event of an emergency.
Minimum 6-8 weeks if the driving foot was operated on/injured.
Pain Medication: Strong pain medication < 72 hrs if needed. A script will be provided at the time of surgery
Decrease to simple pain medication e.g. panadol/nurofen No Alcohol or driving whilst taking strong pain medication

Physiotherapy

6 weeks: gait retraining, Protected WB as above in boot, core strengthening and upper limb program.
12 weeks: may progress with gait retraining, generalised stretching/strengthening fitness program and progressive increase in Lower limb weight bearing exercises, stationery bike, swimming. No eccentric loading until 6 months.
DVT (Deep Venous Thrombosis or blood clots) prophylaxis:
100mg aspirin daily whilst NWB 6 weeks OR other anticoagulation as prescribed
Swelling: Expected to decrease when elevated and gradually decrease over time May have persistent swelling for up to 2 years post surgery.
Travel: It is usually safe to travel short distances on a plane or car 1 week after surgery.
You may experience increased swelling therefore try and keep the limb elevated.
It is more difficult to get around the airport and plane. You will need assistance.
If there is any concern regarding DVT then air travel or long car travel is not advised. In general long haul flights should be avoided for at least 3 months post surgery.
Please take usual precautions for healthy travel such as elevation of the limb, regular movements of the limb and moving around the cabin, stay well hydrated and avoiding alcohol. Additional DVT prophylaxis may be required.

Please discuss any travel plans prior to your surgery
Return to Sports:
Jogging at 4-6 months under supervision of physiotherapist.
Sport specific training may commence at 3 months.
Gradual progressive return to light sports/low impact activities may begin at 6 months.
Return to high impact activities e.g. soccer, football may be considered after 9 months if the patient can perform a single heel raise.
Follow up:
2 weeks – Office for wound review and removal of sutures. Continue Progressive weight bearing in CAM Boot, including when sleeping. Progressively decrease wedges as above
6 weeks – Review integrity of repair. Wean boot as above.
12 weeks – progress review

Concerns:

Please contact the office (during working hours) or attend your nearest Emergency Department with any concerns e.g. increased leg swelling despite elevation for 30 mins, pain in calf, chest pain, shortness of breath, wound ooze, increasing pain despite pain relief