Achilles Tendon Rupture 01
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Special Condition Hx/symptom Signs/objective findings Treatme nt Options Achilles tendon rupture H/O rapid eccentric loading (e.g. jumping, sprinting, stair climbing) Severe pain in the Achilles tendon. Pt may report hearing a pop or feeling as though struck from behind at the time of the injury Positive Thompson's test Observable gap may be present beneath skin between ends of ruptured tendon in midsubstance rupture Exquisite tenderness at rupture site whether it is midsubstance or at insertion into calcaneus Pt unable to perform a toe raise on involved LE Refer Pt to orthopedic surgeon Pt may be treated operatively or nonoperatively Nonoperative Rx: involves casting in PF (6-10 wk) initially. After cast removed, Rx aimed at restoring AROM. Strengthening is then also progressed carefully from isometrics through isotonics and isokinetics. Eccentric loading/strengthening should also be part of later stages of rehabilitation. Some authorities do not recommend this option for an active, athletic patient' Possible rehabilitation approach after operative Rx: Week 1: ice, NWB, AROM out of splint Week 2: ice, NWB, AROM out of splint, isometric inv/ev, gather towel with toes, mobilize scar Week 3: begin PWB in cam-walker or cast with walking boot; if no cast, AROM, gentle calf/Achilles stretch with towel, isometric PF/OF/inv/ev, begin light isotonic PF/OF/inv/ev with tubing (10 repetitions) Week 4-6: progress PWB up to FWB by week 6, AROM, progress calf/Achilles stretching (may begin standing stretch). progress isotonic strengthening, proprioception Week 6-12: FWB in footwear with high heel such as boots, progress stretching, continue isotonics and add toe raises with both LEs Week 12 +. progress all exercises and prudently progress walk to jog; pool exercises Use modalities as needed to assist rehab Baxter, R. Pocket Guide to musculoskeletal Assessment. WB Saunders Company
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Special Condition Hx/symptom Signs/objective findings Treatment Options
Achilles tendon
rupture
H/O rapid eccentric loading
(e.g. jumping, sprinting, stairclimbing) Severe pain in the
Achilles tendon. Pt may
report hearing a pop or
feeling as though struck from
behind at the time of the
injury
Positive Thompson's test
Observable gap may bepresent beneath skin
between ends of ruptured
tendon in midsubstance
rupture
Exquisite tenderness at
rupture site whether it is
midsubstance or at
insertion into calcaneusPt unable to perform a toe
raise on involved LE
Refer Pt to orthopedic surgeon
Pt may be treated operatively or nonoperativelyNonoperative Rx: involves casting in PF (6-10 wk) initially. After cast
removed, Rx aimed at restoring AROM. Strengthening is then also
progressed carefully from isometrics through isotonics and isokinetics.
Eccentric loading/strengthening should also be part of later stages of
rehabilitation. Some authorities do not recommend this option for an
active, athletic patient'
Possible rehabilitation approach after operative Rx:Week 1: ice, NWB, AROM out of splint
Week 2: ice, NWB, AROM out of splint, isometric inv/ev, gather towel
with toes, mobilize scar
Week 3: begin PWB in cam-walker or cast with walking boot; if no cast,
AROM, gentle calf/Achilles stretch with towel, isometric PF/OF/inv/ev,
begin light isotonic PF/OF/inv/ev with tubing (10 repetitions)
Week 4-6: progress PWB up to FWB by week 6, AROM, progress
calf/Achilles stretching (may begin standing stretch). progress isotonicstrengthening, proprioception
Week 6-12: FWB in footwear with high heel such as boots, progress
stretching, continue isotonics and add toe raises with both LEs
Week 12 +. progress all exercises and prudently progress walk to jog;
pool exercises
Use modalities as needed to assist rehab
Baxter, R. Pocket Guide to musculoskeletal Assessment. WB Saunders Company
