Achilles Rehabilitation – Start Early

Achilles Rehabilitation – Start Early

Physical activity during every stage of life can help protect and maintain your overall health. But as your age increases, so does your risk of exercise-related injuries—such as a ruptured Achilles tendon.

 The Achilles tendon connects the heel to the calf. You use it to walk, run, and jump, so it’s constantly under pressure. Over time, this pressure can cause the tendon to become irritated or tear.

A tear in the Achilles tendon (also known as a rupture or snap) is one of the most common Achilles injuries, occurring in about 18 of every 100,000 patients. It typically occurs in men over 30 and continues to increase in patients age 40-59 for two main reasons:

  • Muscles and tendons stiffen with age, making them more likely to snap when stretched.
  • Patients in this age group tend to be “weekend warriors”: people who may not exercise as much during the week and then take part in recreational activities on weekends. This pattern can lead to foot and ankle pain, including Achilles tendon injuries.

However, before moving forward with treatment for any type of Achilles tendon injury, it’s important to understand why the injury occurred and how different treatment options and behavioral changes can prevent it from happening again.

Identifying Achilles tendon injuries.

Achilles tendon injuries are categorized as acute or chronic. Acute injuries include:

  • Rupture: the result of overuse and the lack of a proper warm-up before exercise. It often occurs during sports such as soccer, basketball, volleyball, and softball. When a patient pushes their foot off the ground, they feel a snap as if someone stepped on or threw a ball at the back of their leg.
  • Tendonitis: inflammation that occurs when patients ramp up their exercise too quickly. It can cause ongoing pain and swelling in the heel, ankle, and back of the leg.

Chronic injuries include:

  • Haglund’s deformity: a painful bump that forms on the back of the heel and rubs against the Achilles tendon. It can be caused by a tight Achilles tendon, shoes that are too tight in the heel, or constant walking on the outside of the heel.
  • Heel spur: a pointy calcium buildup on the back of the heel that can cause the Achilles tendon to become more inflamed and harden. It can also be caused by tight shoes and constant pressure on the heel bone.
  • Tendinosis: tendon damage that occurs when tendonitis is not treated. It causes the Achilles tendon to become hard and rubbery.

To diagnose your injury, your doctor or physiotherapist will physically examine your foot and ankle and ask you to demonstrate your range of motion. Then, they’ll perform imaging tests to look for damage in your Achilles tendon. 

Full recovery from an Achilles injury usually takes six to 12 months, regardless of the treatment method. However, the speed at which patients can rebuild strength during this time depends on the type of injury and treatment they have, as well as their personal fitness goals. 

The benefits of minimally invasive surgery.

Ruptures are often treated surgically in patients who are healthy and want to return to their former level of activity. Some studies have shown that surgical treatment can decrease the risk of a re-rupture more than nonsurgical treatment. 

I often recommend minimally invasive surgery for a faster, less painful recovery.

Minimally invasive repair allows the patient to start putting weight on their injured foot sooner than they would with open surgery or nonsurgical care. And the sooner their foot can handle weight, the faster they can start physical therapy and work on getting stronger; early weight bearing leads to better health and strength after six months.

During traditional open surgery, the surgeon makes a 12-cm incision on the back of the leg to access and repair the Achilles tendon. Minimally invasive techniques allow the surgeon to make a 3-cm incision over the Achilles tendon and two smaller incisions at the back of the heel to reattach the tendon to the heel bone.

Smaller incisions result in:

  • Easier wound care 
  • Lower risk of blood loss, scarring, and infection 
  • Shorter recovery

Patients leave the hospital with a cast or boot the same day they have surgery. After a week or so, a doctor will refer you to a physiotherapy where they will examine the pain level and discuss weight bearing options. If readiness is demonstrated, a physiotherapist will guide a basic physical therapy exercise program in preparation for more strength building. 

Alternative treatments, from casting to tendon lengthening.

Nonsurgical treatment for ruptures and all other types of Achilles injuries are recommended for older and less active patients. It typically requires a cast or boot to ensure proper rest for four to 12 weeks; timing depends on how severe the injury is. Ice and over-the-counter pain medications can be used as needed.

Once the patient can put weight on the injured foot, they begin physical therapy to strengthen and stretch the tendon and surrounding muscles. To avoid re injury, they may need to permanently modify or avoid certain activities.

  If a chronic injury is severe, surgery may be an option to:

  • Transfer another tendon to the area to assist with foot push-off.
  • Remove the damaged portion of the tendon.
  • Lengthen the tendon—ongoing stress can cause it to shorten

While you can still walk or even run after an Achilles injury, putting off treatment will only make the injury worse. Seek care immediately to lessen the damage and shorten your road to recovery.

Practical prevention tips.

Taking certain precautions can decrease the risk of injury:

  • Before any form of exercise, warm up for at least five to 10 minutes with a quick walk or jog, in addition to dynamic stretches such as lunges and high-knee skips.
  • Wear athletic shoes that fit.
  • Slowly increase the intensity of your workouts. For example, if you regularly run three miles at a time, don’t suddenly start running five or more; increase your distance no more than 10% each week. 
  • Try different workouts. Repeating the same motion over and over again leads to more pressure on the Achilles tendon. Mix activities that require running with walking, biking, swimming, or yoga.
  • Always stretch after exercising and pay extra attention to calf muscles. Tight calves can increase pressure on the tendon.

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