Achilles Tendon Rupture

Achilles tendon rupture are common. Most athletes describe a sudden acute event with an associated popping sensation and pain in the Achilles tendon. They often think that they have been kicked or struck in the calf. It is important to get prompt treatment and to be placed in an equinous cast (a cast with the foot in a pointed position). More definitive treatment options can be discussed after this has occurred.

There are a number of treatment options available for patients with Achilles ruptures. In general these involve surgical repair of the tendon followed by casting or immobilisation of the tendon with the ends opposed (in an equinous position). There is often a lot of discussion about which is best. In reality there is no best solution for everyone and treatment decisions are made on an individual basis with the patient. The most important thing is to get the tendon to heal and for it to heal at its normal length. How this occurs is less important.

Mr Bruce Twaddle, one of the UniSports Orthopaedic Surgeons, has developed an accelerated non-operative treatment program for managing this injury. We have had good success with this regime in both recreational and elite athletes. This protocol uses a moonboot rather than with the plaster of paris cast which is generally used. The advantage of this protocol is that it allows you to do some basic ankle and foot exercises to limit muscle wasting and joint stiffness. In the later stages we are also happy for you to remove the boot for sleep.

If you would like to consider using this protocol ask your primary care provider to refer you to one of the Sports Physicians to see whether this might be appropriate for you.

Achilles Ruptures – Sports Physicians' Protocol

  • Equinous cast immediately for two weeks.
  • Window cast or remove and check that there is no palpable gap in the tendon.
  • Non-Weight Bearing (NWB) 30° equinous AAFO boot for one week
  • During this time the boot can be removed for range of motion (ROM) exercise for five minutes an hour. It is important that you do no stretching and that the foot is not flexed up beyond neutral. If you are unsure about this discuss this with your doctor.
  • NWB 20° equinous boot for 1 week – still wearing this at night and still no stretching.
  • NWB 10° equinous boot for 1 week – still wearing this at night and still no stretching.
  • NWB 0° equinous boot for 1 week – still wearing this at night and still no stretching.
  • From six weeks post-injury you can weight bear in the boot. Can remove the boot in bed at night. By eight weeks the goal is to be weight bearing fully in the boot.
  • From eight weeks you can come out of the boot and start a strengthening program. When you can support your weight on one leg your strengthening program can be more aggressive.  Be very cautious with stretching, start slowly after 8 weeks.
  • If the Achilles appears to have healed long we will arrange for you to have a heel raise for your shoe.
  • A review and clinical check with your doctor at each stage of the protocol is needed to make sure that the tendon is healing normally.

Whichever protocol you use to treat your Achilles tendon rupture you are likely to require some form of immobilisation for about eight weeks. It is likely to be a minimum of six months before you are back to playing sport.