The Achilles tendon connects the calf muscle, comprised of the gastrocnemius and soleus muscles, to the heel bone in the foot. This tendon connection allows the calf muscles to move the foot in both plantar flexion (downwards) and dorsi flexion (upwards) and is vital to sprinting, jumping and other activities. The tendon is made up of strands of interwoven collagen fibers. When the tendon ruptures, these strands can detach from the calf muscle. Surgery is usually performed to reattach the tendon. Recovery time can take six months or longer, and it is important to follow the right guidelines to rehabilitate the tendon and rebuild the calf muscle. Always consult with your physician prior to beginning any new protocol for an Achilles tendon rupture.
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Initial Treatment Options
Most patients who have an Achilles tendon rupture undergo surgery. The chances of returning to full strength are good and there is a less than five percent chance of reinjury. Following surgery, you will be on crutches and in a hard cast for two to four weeks. It is important to try to keep the foot elevated above the heart as much as possible to reduce swelling. There should be no weight bearing on the injured foot, as this could cause reinjury early in the recovery process.
Initial Movement Rehabilitiation
After the cast comes off, you will be in a walking boot and can begin the initial stages of rehabilitation for the injured tendon and calf muscle. You can begin weight bearing on the injured foot as long as it is in a walking boot, and initial range of motion exercises can begin. You should perform ankle flexion-extension and ankle circles for 20 reps each, three times a day. Swelling may occur, and you should still try to keep the foot elevated above the heart as much as possible.
Beginning Strength Exercises
Approximately eight to 12 weeks following surgery, you may begin basic strength exercises for the injured ankle. You should remain in a walking boot and also continue elevating your leg whenever possible to reduce swelling. For this initial strengthening period, use a light elastic band wrapped around the ankle. Using the band for light resistance, practice plantar flexion (toes pointing down); dorsi flexion (toes pointing up); ankle inversion (rotating inwards); and ankle eversion (rotation outwards). Thirty repetitions of each once a day is the recommended amount. Always consult with your physical therapist or doctor prior to beginning strength exercises after surgery.
Building the Calf Muscle Back to 100 Percent
From 12 weeks onwards, you may be able to begin walking without assistance (always get clearance from your physician ahead of time). You should continue exercises with the elastic band and can progress to a heavier resistance. You can also begin more complex exercises, including calf stretches, calf raises and single-leg balancing. For calf raises, begin for the first couple months using both legs simultaneously, performing the exercise every other day. After two to three weeks, begin calf raises on two feet while lowering only on the injured foot, 10 repetitions every other day. Finally, within six months of the operation, you should progress to performing calf raises only on the injured foot. Expect to return to light exercise approximately six to eight months post-op and to full sport activity by eight to 12 months post-op.