What are the management options for an Achilles tendon rupture?
An acute Achilles tendon rupture can be managed non-operatively if the ankle has been appropriately immobilised in an equinus frontslab in the first instance. The theoretical advantages of surgical repair include a more anatomical apposition of the tendon ends which in turn, should improve push-off strength and have a lower re-rupture rate. Other factors which may influence the type of treatment chosen include the patient’s medical comorbidities (such as cigarette smoking and diabetes mellitus) and their functional demand.
What is the recovery after an Achilles tendon repair?
After your Achilles tendon repair, you will be non-weight-bearing through your operated ankle for 2-4 weeks, and can then progress to protected full weight-bearing for another 8-10 weeks. You will be immobilised in a below-knee plaster frontslab with your ankle in resting plantarflexion for 2 weeks, and can then transition to a CAM boot with a 3 centimetre heel raise orthotic. You will need to wear your CAM boot when ambulating only for this subsequent 8-10 weeks, and should gradually decrease your heel raise when you start weight-bearing. You can start ankle and foot range of motion exercises after 2 weeks, but should avoid ankle dorsiflexion past plantigrade for 12 weeks post your Achilles tendon repair. Once your surgical dressings have been removed after 2 weeks and your wound is healed, you will be encouraged to desensitise your surgical scar by massaging your wound with a moisturising cream/oil. For most patients, it will take 2-3 weeks for your wound to heal, 3-4 months for your Achilles tendon to regain its functional strength, 6-7 months before you are reasonably comfortable jogging again, and up to 12 months for the swelling in your ankle to subside and for full recovery to your new baseline level. Your risk of re-rupturing your Achilles tendon can be reduced by adequate physical rehabilitation and activity modification as required.