I ruptured my left Achilles tendon and went to see a pretty hip ortho guy. He put me on a fast-paced rehab program instead of doing the usual surgery. It seemed to whiz by. Two weeks in a special splint: no motion and no weight on the foot. Before I knew it, I was in a special boot, putting weight on it and moving the foot. But for all that speed, I still felt like it took a very long time to really get back to full sports participation. So what's all the hype about this "accelerated rehab" program?
Even with conservative care and an aggressive rehab program, Achilles tendon ruptures simply take a long time to heal. Part of the time delay is the fact that the worry with Achilles tendon rupture has always been that the tendon would re-rupture with too much too soon. So, in the past, these injuries were always treated with cast immobilization with no weight on the foot. That protocol was used for both conservative care and after surgery.
Now there is some evidence that introducing two key components (early weight-bearing and early motion) really helps speed up the healing and recovery process.The first two weeks after injury is a period of non-weight-bearing and immobilization. During that two-week period of time, patients are put in a special splint and keep weight off the foot.
After two weeks (and for the next four weeks), the splint is exchanged for a boot brace with a heel that protects the healing tendon. During that time, ankle motion is allowed from a toe pointed down position (called plantar flexion) to a neutral alignment. By the end of eight weeks, patients are out of any protective boot at all and allowed to move the foot freely and put full weight on it.
With this protocol, athletes can go from injury to retraining for a return-to-sports in as little as eight weeks. That is the best case scenario to date. Eliminating the added risks that come with surgery improves the odds that the athlete will stay on course and get full recovery without delays. Researchers will continue investigating this topic. There may be other ways to aid recovery and reduce the amount of time it takes to go from injury back to the field or court. Hopefully future studies will bring those to light and further reduce the time it takes to fully recover after an acute Achilles tendon rupture.
Kevin R. Willits, MA, MD, FRSCC. Treating the Acute Disruption of the Achilles Tendon: The Nonoperative Option. In Orthopedics Today. January 2011. Vol. 31. No. 1. Pp. 62.
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