Tendon Rupture > Treatments
When conservative treatment of your Achilles tendon
rupture is prescribed, you typically have your ankle
immobilized in a short leg cast for about six weeks.
Non-surgical treatment is most successful when started
within 48 hours of the injury. Most of the time, the
cast is applied in your physician's office immediately
after the diagnosis is made. You usually are instructed
to use crutches and not bear weight on your ankle while
wearing the cast.
short leg cast wraps around your foot, ankle, and lower
leg; it starts below your knee and is open around your
toes to allow toe movement.
leg casts typically are made of layers of fiberglass.
Your physician usually rolls a thin elastic stocking,
called a stockinette, over your skin, and cast padding
is placed around your foot and ankle.
dry layer of fiberglass is then wrapped around your
leg and foot. Extra fiberglass strips are wrapped around
the sole of your foot. Additional fiberglass layers
are applied wet over the first layer.
the short leg cast dries, it should immobilize your
ankle but allow you to move your toes. It should be
snug, but not tight.
Your foot usually is put into the cast in a slightly
bent downward position, called gravity plantar flexion.
This is the natural position of your foot hanging down
with the force of gravity. Physicians sometimes order
(magnetic resonance imaging) after your cast is applied
to check to see if the two ends of the ruptured tendon
are aligned correctly. Over the course of six weeks,
you go back to your physician for new casts until your
foot is brought up to a neutral position, in which your
ankle is not bent. Though every physician has a slightly
different way of treating Achilles tendon ruptures in
a cast, the general schedule is as follows:
weeks - Return to your physician for a new cast that
immobilizes your foot in a less bent-downward position.
to four weeks - Your physician may bring your foot up
to a neutral position in either a walking cast or brace,
called a cam walker, and you usually can begin bearing
some weight on your ankle.
weeks - Begin wearing a cam walker or supportive shoes
with an orthotic heel lift, and begin bearing more weight
on your ankle.
You should always keep your
cast dry when recovering from an Achilles tendon rupture.
Your physician can show you how to wrap plastic around
it while showering, or you may be able to bathe with
your lower leg out of the tub. Physicians generally
recommend that you avoid bearing weight until your tendon
has healed. Crutches are usually prescribed for about
four to six weeks after an Achilles tendon rupture.
In general, you can begin some weight on your ankle
when you are put into a walking cast or cam walker sometime
between two and four weeks after the initial cast is
applied. You may find it difficult to use crutches,
but it is essential to keep as much weight as possible
off your ankle for the first few weeks. The more weight
you put on your ankle, the greater your chances of straining
your healing Achilles tendon tissue. Household tasks
that require you to be on your feet may be difficult
for several weeks. It can be helpful to have someone
around the house who can help with any physical chores.
Your physician may prescribe range of motion exercises
for you to perform at home after your cast is removed.
The goal is to avoid pain and stimulate blood flow and
circulation. Patients generally are instructed to remove
their ankle brace for a brief period and prop their
lower leg on a stool or pillow so your ankle is off
the floor. Physicians generally recommend moving your
ankle up, down, and side-to-side. Start with slow movements
and do not move your ankle too far in any direction.
When the cast comes off, you should not feel pain, but
your ankle will likely feel weak and stiff. Movement
and walking may be awkward at first. Because of the
risk of re-rupture when you have not had surgery, your
physician generally evaluates your ankle after six weeks
and often refers you to a physical therapist, who can
supervise your progress and test your tendon strength.
The recovery period after a ruptured
Achilles tendon usually lasts for many months. Without
surgery, your tendon may lose some of its original strength
and your physical therapist can help determine what
activities are safe for you. You typically progress
from range of motion exercises, to light cardiovascular
exercise, and then strengthening exercises. If you experience
episodes of minor swelling or pain while exercising,
have your physician examine your ankle. Physical therapy
usually involves learning an ankle stretching routine
and performing foot and lower leg strengthening exercises.
The following ankle stretching exercises are commonly
Avoiding another rupture of your Achilles tendon usually
requires caution during sports and activities. Patients
who receive conservative treatment for their ruptured
Achilles are at a higher risk of re-injury, but usually
these patients are older and are not trying to return
to competitive athletics that put heavy strain on their
Achilles tendon. Sports that require quick starts and
stops, sprinting, and jumping may increase your risk
of re-injuring your Achilles tendon. Incorporating cross-training
into your workout schedule can be helpful. For example,
instead of running every day, alternate between running
and swimming workouts. Warm up before participating
in activities and stretch your calf muscles, Achilles
tendons, and feet both before and after activities.
You should increase the duration and intensity of your
workouts by no more than 10 percent per week and avoid
serious sprinting and hill climbing unless you have
worked up to a high fitness level and you have talked
with your physician. Choose athletic shoes that properly
fit the shape of your foot. Continue to wear orthotic
inserts and heel lifts if recommended by your physician.
If your ankle starts to hurt during exercise, you should
return to your physician’s office for a check-up.