My surgeon has been very upfront with me about rehab following an Achilles tendon rupture repair. She says there are studies to support putting weight on the foot after surgery. There are also studies that say it's not a good idea to put weight on the foot right away after surgery. What do you recommend?
Achilles tendon rupture (complete tear of the calf muscle tendon that inserts into the back of the heel) can be treated conservatively without surgery. But the best results usually come with surgery to repair the damage. There's less risk of reinjury with surgical reconstruction.
Surgery comes with a risk of wound-healing problems and damage to the sural nerve of the foot. Surgeons have tried various ways to increase the strength of the repair but so far, nothing has really made a difference in terms of added benefit with these approaches.
Studies have been done comparing outcomes with early weight-bearing and mobility versus delayed (six weeks post-op) weight-bearing. Some studies used an ankle-foot orthosis (AFO) (brace) to support the joint during the early recovery phase. Patients are told to put as much weight as they want or feel comfortable putting on the foot. This is called weight-bearing as tolerated.
The studies show that patients who wait four to six weeks before weight-bearing and those who weight-bear as tolerated right after surgery have the same results by the end of six months. Getting up on the foot early makes the patient feel better overall. In terms of any limitations caused by putting weight on the foot early, there were none.
The real concern about putting too much weight too soon on the operated side is that the healing tendon might re-rupture. But, in fact, this hasn't really happened. Patients report that the improved mental health and quality of life early on after surgery make it worth getting up sooner than later.
Your surgeon may have a feeling about what would work best for you given all things considered. If not, then weight-bearing as tolerated may be an acceptable approach for you. A physical therapist will help you learn how to walk with crutches (or a walker if you need more support), so you'll have some support and some guidance. Take it slow and easy at your own pace. You can always back off it doesn't feel right to you. And don't hesitate to check in with your surgeon if anything comes up that concerns you.
Randall C. Marx, MD, and Mark S. Mizel, MD. What's New in Foot and Ankle Surgery. In Journal of Bone and Joint Surgery. February 2010. Vol. 92-A. No. 2. Pp. 512-523.
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