Non-Operative Achilles Tendon Program – Phase 5
At 8 weeks from injury:
Transition out of the boot into regular footwear, but with a heel or a small wedge in the shoe (put in both shoes or it feels strange).
No need to wear the boot at night.
Increase the weight-bearing and wean off crutches altogether. Increase the range of motion exercises to 6 times a day but still DO NOT come beyond neutral.
Commence two-legged toe raises, adding increasing load to the injured leg. Practise seated toe raises, adding weight to the knee on the injured side to activate the calf and begin to load the tendon concentrically.
NEVER STRETCH THE TENDON. Load improves the quality of the collagen as it matures, but it is a slow process for it to organise itself and it can’t be hurried.
At 10 weeks, doing pool therapy is useful – walk down a sloped pool until you can single-leg toe raise with the water supporting you, holding on to the side, and gradually work your way up the slope of the pool until you can single-leg toe raise and support your weight. Initially you can go up on two and then see hold the weighted position as the injured side drops. DO NOT rush this step as the tendon is still at risk of re-injury.
Once you can single-leg toe raise, you can progress with exercise as you feel comfortable – this is never before 4 months from injury and may take up to 9 months.
Note: measuring “length” with the patient prone and both legs extended is not accurate, as the injured side will appear slightly long until the muscle bulk has returned. A more accurate measure is with the patient prone and both knees bent to 90 degrees, then gently press down on both feet. The injured side should be slightly shorter with a reactive squeeze test with the legs extended.