Rehab.
Starting with the removal of the cast one month after surgery, it is carried out in three stages. Early and mid-term training aims to loosen ankle and heel injuries, postoperative adhesions, and restore ankle extension and flexion mobility and fine motor regulation functions. The early stage (46 weeks postoperatively) was based on the non-impedance extension and flexion functional activities of the ankle joint in bed. In the middle stage (1.5-3 months after surgery), you should walk on the ground and further functional exercises, such as walking forward and backward, pedaling power bicycle, foot rolling log exercises, etc. At the beginning of the training, the heel of the shoe should be padded appropriately to reduce the tension force on the Achilles tendon, and then gradually lower the heel after adaptation. In the later period (3-6 months after surgery), muscle strength training to restore the ankle heel muscles and tendons against tension, such as weight-bearing heel exercises, ankle dorsiflexion resistance exercises, etc., is the main focus, so as to make final preparation for returning to the training field.
Post-suture rehabilitation procedures.
I. Early period – flexion 30 degree plaster fixation period (0-4 weeks)
Purpose: To reduce pain, swelling; early muscle strength exercises to avoid muscle atrophy as much as possible.
(i) Day of surgery.
After the anesthesia subsides, start to move the toes; if the pain is not obvious, try to contract the quadriceps (i.e., tensing and relaxing the anterior thigh muscles).
(II) The day after surgery.
1. Move the toes – forcefully, slowly, and as widely as possible. But never cause ankle joint movement! 5 minutes/group, 1 group/hour. (Important for promoting circulation, decreasing swelling, and preventing deep vein thrombosis)
2, quadriceps (anterior thigh muscle group) isometric exercises – that is, thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (Greater than 500 times/day)
(iii) 2 days after surgery.
1.Continue the above exercises.
2.You can walk on your feet without touching the ground with the help of crutches, but only to go to the toilet but necessary for daily activities.
3.Start to try leg lift – leg lift to heel 15M from bed, hold until exhaustion. 10 times/group, 2-3 groups/day (may not be completed due to heavy cast.) .
Depending on the nature of the injury and surgery, the plaster cast should be worn for about 3-4 weeks in order to allow the Achilles tendon to heal firmly. During the period of fixation, only the above mentioned exercises can be performed without the doctor’s permission, blind movement is likely to cause injury!
Second, the middle period – mobility and muscle strength exercises period (4-12 weeks)
Review, and depending on the situation, the cast will be removed by the doctor at 3 or 4 weeks to below the knee joint. It must be worn for the rest of the time, except during exercises!
Purpose: To start mobility exercises, strengthen the leg muscle exercises, start weight bearing exercises and gradually return to normal gait walking.
(I) 4 weeks after surgery: (Start joint mobility exercises as determined by the doctor.)
1.Start lateral leg raising exercises, 30 times/group, 2-4 groups/day with 30 seconds rest between groups.
2.Start ankle mobility exercises: actively flex and extend the ankle joint, i.e., slowly, forcefully and maximally tense the toes and hook the toes. (Within the range of no or minimal pain! Because the early tissue healing is not yet strong enough, excessive stretching may cause undesirable consequences.) 10-15 minutes/time, 2 times/day. Soak feet in hot water for 20-30 minutes before practice to increase tissue temperature to improve extensibility and enhance practice effect.
3.Start knee flexion exercises (due to long time fixed knee mobility will be reduced, so there may be pain at the beginning of the exercise, persistent practice can be improved.)
4.Start extension exercises (seated suspension): put a pillow at the heel, make the affected leg leave the bed completely, relax the muscles to make the knee joint extend naturally. 30 minutes/time, once a day, until the affected leg can be straightened and the healthy leg is the same.
5, start leg muscle exercises: to restore the thigh muscles atrophied during the plaster fixation period. Practice absolute strength, choose a medium load (complete 20 times the movement that fatigue load), 20 times / group, 2-4 groups of continuous practice, rest 60 seconds between groups, until fatigue.
(B) 5 weeks after surgery.
1.Start “roller” exercises: choose a solid cylinder (such as wine bottles, cans, etc.), repeatedly practice 20 minutes, soak your feet and sit on a chair, bend the affected foot on the cylinder and step on the cylinder to roll back and forth, gradually increase the force and increase the degree of activity, 1-2 times a day.
2, can hold a single crutch foot walking on the ground.
3. Strengthen the muscle strength exercises.
(C) 6 weeks after surgery: remove the plaster rest
1.Cut the cardboard into the size of the heel of the shoe and put it in the heel of the shoe about 3 cm, and start walking with the crutches, and remove the cardboard layer in about 2-3 days, and finish it in 2-3 weeks, and transition to walking with flat shoes.
2.Start front-to-back and side-to-side striding exercises. Note: There should not be excessive pulling at the Achilles tendon!
(iv) 7 weeks after surgery.
1.Start static squatting or sliding exercises against the wall to strengthen the leg strength.
(v) 8 weeks after surgery.
1.Strive to achieve normal gait walking within one to two weeks.
2.Strengthen the intensity of pedaling exercises, gradually transition, and gradually increase the load, 30 times / group, 4 groups / day.
3.Strengthen the muscle strength, and start the knee exercises of 45° single leg flexion and extension on the affected side. 5 minutes / time, 4 times / day.
Third, the late stage: (3 months)
Purpose: To strengthen the joint mobility to the same flexibility as the healthy side. Strengthen muscle strength and improve joint stability. Resume daily life and gradually regain motor ability.
1.Fixed bicycle exercises, no load to light load, no obvious pulling sensation at the Achilles tendon. 30 minutes/time, 1-2 times/day.
2.Start pedaling exercises.
3.You can start swimming. But absolutely avoid slipping!
During this period, the sutured tendon is not strong enough, so the exercises and training should be gradual, not forced or blindly adventurous. You should strengthen the muscle strength to ensure the stability of the ankle joint in sports, and you should pay attention to safety and absolutely avoid falling again!
IV. Recovery period: (after 3 months)
Purpose: To resume sports or strenuous activities. Strengthen the muscle strength and start running and jumping exercises.
1, three months later you can start the transition from slow walking to fast walking exercises.
2, 5-6 months to start heel lifting exercises, double foot heel lifting gradually transition to single foot heel lifting.
Heel lifting exercises – that is, standing on the tips of the feet, including the feet stand apart and shoulder width, the tips of the feet are forward; “outside the eight” standing; “inside the eight” standing three positions. 2 minutes / time, rest 5 seconds, 10 times / group, 2-3 groups / day.
3.Progressive step by step! According to their own practice gradually brisk walking – jogging – fast running – jumping.
4.Start to resume exercise at 10-12 months.