0 – 2 Weeks Post Operatively

Vacoped boot placed on leg while under anaesthetic, locked in equinus (foot pointing down, 30 degrees) Full weight-bearing mobilization (as much weight as comfortable). (Early weight bearing has been shown to statistically improve time to return to activities including work, sports, and normal walking)
2 crutches until confident to walk without
Anaesthetic block may take up to 24 hours to wear off (you may be numb and weak from the knee down)
Regular pain relief as required (Eg. Paracetamol, Coedine and Diclofenac)
Strict elevation at the level of the heart, for 23 hours a day for 7 days (for pain relief and wound healing)
Elevation at the level of the heart, for 12 hours a day for 7 further days

Bandage and the Dressing – After 48 hours
After 48 hours, remove the white bandage (and gauze underneath) yourself.
A dressing will remain underneath – leave this on. There may be some blood staining on the dressing, this is normal.

You can have a light shower but wrap cling film around the dressing to aid waterproofing. Do not have a bath until the wound has been reviewed by Mr Gordon at 2 weeks after surgery.

Evenup device to equalise leg lengths while wearing Vacoped boot

The Boot (VacOped)
Vacoped fitting instructions can be found here

The boot should not be removed for the first 2 weeks. Only after then and with caution, can the boot be removed. It can be removed when seated, for bathing, but when off, no weight through foot. Always keep the foot in a tip toe position when the boot is off.

Sleeping
The boot must remain on during sleep until the end of the 6^th week

After 2 Weeks Post Operatively (Post Operative Week 3)
Outpatient visit – Seen by Mr Gordon
Vacoped boot removed, wound inspected and stitches trimmed
Continue full weight-bearing
Start physiotherapy – at home and in outpatients (see below)

Adjustment of Vacoped Boot:
The boot will be set by Mr Gordon following the operation, while you are asleep.
Please read the instructions on how to adjust the boot

At week 3 and for all subsequent weeks, only adjust the lower ‘screw’ using the key provided, this will allow more ankle movement in a gradual and controlled manner.
One notch on the boot equals 5 degrees.

Follow the protocol below:

8 Weeks Post Operatively

Outpatient visit – Seen by Mr Gordon

Assessment of tendon healing, ankle motion, calf power, gait

Discard boot and into normal shoe full weight bearing

Continue physiotherapy

3 Months Post Operatively
Outpatient visit – Seen by Mr Gordon
Assessment of tendon healing, ankle motion, calf power, gait, discuss sporting aspirations
Continue physiotherapy
Start jogging

6 Months Post Operatively
Outpatient visit – Seen by Mr Gordon
Assessment of tendon healing, ankle motion, calf power, gait, discuss sporting aspirations
Continue physiotherapy if required
Start sports requiring explosive activities

Driving
You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe at 2 weeks post operatively. For right sided surgery, driving is probably safe at 9 weeks post operatively, once in a normal shoe. If you are unsure, please ask Mr Gordon.

Return to Sport
There is a lack of evidence to recommend specific timings for returning to sport. A decision should be made with in consultation with Mr Gordon and your physiotherapist. Above timings are guidelines only.

Rehabilitation Guide for Physiotherapists

Post Operative Week 3 & 4
Soft tissue massage
Out of boot : Passive range of motion, gentle active plantar flexion, limit dorsiflexion to gravity in prone position
Exercise bike with boot on

Post Operative Week 5 – 8
Active plantar flexion with Theraband
Seated heel raises
Out of boot : Full plantar flexion, inversion and eversion, limit dorsiflexion to number of heel raises in degrees (see Rehabilitation Summary table)
Proprioception/balance, Gait re-education

Post Operative Week 9 onward (boot discarded)
Gentle weight bearing dorsiflexion stretch (lunge position)
Eccentric/Concentric loading (bilateral to single. Emphasise eccentric phase)
Single stairs
Progress to upslope and downslope
NWB aerobic exercises – e.g. cycling (push with heel, not toes).
Monitor inflammation signs and rehabilitation accordingly
Discard crutches (if still needed) when dorsiflexion 10⁰

3 Months Post Operatively
Jogging progressing to fast acceleration & deceleration
Directional running / cutting
Pylometrics. e.g. toe bouncing upwards / forwards /directional

Reference List
Cetti, R., L. O. Henriksen, and K. S. Jacobsen. “A new treatment of ruptured Achilles tendons. A prospective randomized study.” Clin.Orthop.Relat Res.308 (1994): 155-65.

Costa, M. L., et al. “Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study.” Injury 34.11 (2003): 874-76.

Kangas, J., et al. “Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study.” J.Trauma 54.6 (2003): 1171-80.

Maffulli, N., et al. “Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendonrch this journal.” Am.J.Sports Med. 31.5 (2003): 692-700.

Mortensen, H. M., O. Skov, and P. E. Jensen. “Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study.” J.Bone Joint Surg.Am. 81.7 (1999): 983-90.

Suchak, A. A., et al. “Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis.” Clin.Orthop.Relat Res. 445 (2006): 216-21