Your Recovery from Achilles Tendon Rupture
If you are reading this, then you have almost certainly suffered
a rupture (or tear – the two words mean the same thing) of your
Achilles tendon.
N.B. If someone has suggested that you might have a “partial
tear” then get if checked. Partial tears are incredibly rare.
Failing to treat a full tear properly can have serious
consequences.
The outcome after Achilles rupture is extremely good, but the
recovery is ALWAYS long. Ten weeks in a supportive boot and then
months of physiotherapy exercises. It will be a minimum of six
months before you can consider any competitive sport.
Phases of Recovery
There are FOUR PHASES to your recovery:
Phase 1 - First Aid, provisional diagnosis and limb
splintage
In the Emergency Department you will be assessed. If an
Achilles rupture seems likely then your leg will be splinted
in a tip-toe position (deliberately) with plaster or a
special support. You need crutches and should discuss using
blood thinners to protect you against thrombosis (blocked
veins that can be dangerous if they affect the heart or
lungs).
The specialist team will be alerted and an appointment made
to plan the next steps for your treatment.
N.B. Do NOT walk upon or remove the protective healing.
Phase 2 - Specialist assessment for treatment planning
After assessment by your specialist (and a scan if advised)
you will either be offered surgery (~10%) or advised that an
excellent outcome with non-surgical treatment is expected
(~90%).
The best evidence available shows that in 90% of cases no
surgery is required. The tendon heals well, as long as the
two torn ends are close together. A scan can be useful to
check this.
You will be fitted with a boot or plaster that continues to
hold you in the tip-toe position. Further blood thinners to
protect against thrombosis may be prescribed. Usually, you
are allowed to walk on the boot at this stage, but you MUST
maintain the tip-toe position at all times. When you take
the boot off for a (very careful) wash, only do so whilst
seated.
N.B. One mistake can take you right back to square one.
Phase 3 - Adjusting your boot
After about 5 weeks you will begin (following review in
clinic or with instructions) to adjust your boot. There are
different boot designs, but broadly speaking they either
have a hinge which can be gradually unlocked or heel wedges
that are removed, layer by layer, to reduce the degree of
tip-toes.
N.B. Tiptoe position MUST still be maintained at ALL times.
If the position is lost then the tendon will stretch or tear
again.
Phase 4 - Physio, freedom and the slow return to
normal
After ten weeks have elapsed you rely less upon the boot (it
is still wise to use it in crowded or unpredictable
situations) and physiotherapy commences. The aim is to
improve the power in the calf muscle, which is quite thin by
this time. You should NOT do stretches (even if the tendon
feels tight) for many months. The tendon remains a little
soft for ages, so if you stretch it then the tendon
elongates and the leg does not work quite as well as it
should.
N.B. Full recovery takes many months. The injured tendon
will be permanently a little thickened and the calf muscle a
bit thinner than it used to be (but powerful enough to work
perfectly well).
