Postoperative rehabilitation of fresh Achilles tendon injuries

  Achilles tendon rupture is the third most common tendon rupture. The most common mechanism of Achilles tendon rupture is a sudden and unexpected dorsiflexion of the weight-bearing forefoot while the knee is straight, or a sudden and unexpected dorsiflexion of the talocrural joint or landing on the ground that causes severe dorsiflexion of the already plantarflexed foot. The Achilles tendon rupture is associated with a relatively sparse blood supply 2-6 cm above the Achilles tendon stop, and degenerative damage is also a cause. The diagnosis of Achilles tendon rupture is confirmed by localized depression of the Achilles tendon on examination, inability to stand on the toes of the affected foot, and a positive Thompson’s “squeeze test”.  The debate on the best rehabilitation plan after Achilles tendon repair is as complex as the choice of the best treatment. The following post-operative management plan is currently followed: 1. Immobilize the foot in a gravity-defying position with a short-legged tubular cast after surgery.  The cast is removed at 2 weeks, the wound is observed, the sutures or staples are removed, and the foot is fixed in the same short-legged cast (in the gravity-depressed position) for 2 weeks.  The cast was replaced at 4 weeks, and the foot was gradually returned to the plantar position within the next 2 weeks, during which time partial weight-bearing walking with crutches was gradually resumed.  4.At 6-8 weeks, the foot is fixed in the plantar-row position with a short-legged walking cast and can be fully weight-bearing. Begin gentle active range of motion exercises of the talocrural joint for 20 min each time, twice daily. Begin isometric contraction exercises of the talocrural joint, and begin knee and hip strength exercises at the same time.  5.The third stage of rehabilitation includes toe standing, gradually increasing resistance exercises and proprioceptive exercises, as well as whole-body muscle strength exercises.  At 12 weeks, a 90° ankle dorsiflexion restriction brace or similar device may be worn until nearly full range of motion is restored and the muscle strength of the affected limb reaches 80% of the contralateral side, usually within 6 months.