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�� Phone574.247.9441● Fax: 574.247.9442● www.sbortho.com chilles upture onoperative rotocolPage of Last Updated September 3, 2020 ACHILLES RUPTURE: NONOPERATIVEPROTOCOL Phase 1: Protection and Healing 8 weeks WEEKSplint to plantar flexion NO WEIGHT BEARINGin splint Elevate leg above heart 23 hours/day WEEKS Walkingboot with 20o plantar flexion heel lift (3 wedges)Nonweightbearing with crutchesRemove boot in seated position with lower extremity hanging free off table/chair/bedActive ankle dorsiflexion to neutral only followed by passive gravityassisted plantar flexion as har as is comfortable onlyModalities as indicated WEEK: Begin protected weight bearing IN BOOT with 3 wedges tart with 25% weight, progress 25% per week until 100%Take one wedge out per weekMonitor for swelling, use modalities for swelling and pain control.Wear CAM boot or splint while sleeping until 8 weeks postinjury GOALS Return to normal gait WEEKS Weightbearing in boot with crutchesMay remove boot for sleepingContinue exercise protocol WEEKS Wean from boot to shoes with gel heel liftSLOWLY transition to regular shoe wear �� Phone574.247.9441● Fax: 574.247.9442● www.sbortho.com chilles upture onoperative rotocolPage of Last Updated September 3, 2020 Inititiate toeraising exercises using the unaffected leg to support injured legOnce able to perform toeraises with the injured leg unsupported, may begin Achilles stretching, strengthening and proprioception exercises WEEKS Progress balance with dynamic activitiesInitiate retro walking if patient has appropriate dorsiflexion ROM (510 degrees active)Continue to progre

2 ss ROM, strength, and proprioceptionRetr
ss ROM, strength, and proprioceptionRetrain strength, power, and enduranceIncrease dynamic weightbearing exercise, including plyometric trainingSportspecific retrainingPatient required to wear the boot while sleeping for first 6 weeksPatients can remove the boot for bathing and dressing, but are required to adhwere to the weightbearing restrictions according to the rehabilitation protocolPhase 3:Retrain12 to 24 eeks GOALS Improve functional mobility with stairs.Improve tolerance for ambulationStrength to WNLROM to WNLProgress to return to prior level of activity/ sport MONTHS Progress progressive resistance exercises (PREas tolerated with focus on eccentric control withplantar flexionProgress closed chain activitiesProgress walking program, may progress to walk/ jog when able to perform minimum 1520 single leg toe raises with good controlNonathletic patients may be discharged to HEP/ Gym program DRIVING Right foobegin at 8 weeks if surgery as long as off narcoticsLeft footmay drive when off pain meds if automatic transmission vehicle BIKING/SWIMMINGay begin at 8 weeks post RUNNING/HIGH IMPACTay begin 46 months after surgery FULL ACTIVITYeturn tosports may begin when you can come up and down on your toes (single heel rise) or hop (single leg hop) on the surgical side. This may take 6 months to a year.There is no guarantee on outcome. All conservative management options have risk of worsening pain, progressive irreversible deformity, and failing to provide substantial pain relief. All surgical management options have risk of infection, skin or bone healing issues, and/or worsening pain. Our promise is that we will not s

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top working with you until we maximize your return to function, gainful work, and minimize pain. SHOWERING: You may shower with soap and water 1 day after surgery. Avoid lotions, creams, or antibiotic ointments on surgical site until directed by your orthopaedic surgeon. No baths or submerging operative site under water until incision has completely healed. SKIN CARE: incisions may become sensitive. Some surgical incisions based on their location and patient factors are more likely to require postoperative scar desensitization with physical therapy. You may use Mdermaor other skin protectantlotion once incisions have completely healedand approved by your orthopaedic surgeon. Do not placed cortisone or other steroid on your incision unless directed by your orthopaedic surgeonIncisions and surgical site scars are more prone to burn by ultraviolet radiation when out in the sun. Always apply sun screen onto the healed incisiononce fully healed. STOOL SOFTENER: While on narcotic pain medication (e.g. Norco/hydrocodone or Percocet/oxycodone) especially within first 72 hours of surgery, you should take stool softener (e.g. Miralax, docusate, senna). Discontinue if you developloose stool or diarrhea. �� Phone574.247.9441● Fax: 574.247.9442● www.sbortho.com chilles upture onoperative rotocolPage of Last Updated September 3, 2020 REFERENCES Westin et al. Acute Ultrasonographic Investigation to Predict Rerupture and Outcomes in Patients with an Achilles Tendon Rupture. OJSM Lantto et al. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. AJSM 20