Intermediate Achilles Tendon Rupture Repair Rehab

The Achilles tendon is the biggest and strongest tendon in the human body and is formed by the tendons of the soleus and gastrocnemius muscles which both insert at the calcaneus. We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete.

While a scientific review from the year 2017 showed no significant differences in the outcomes of surgical and conservative management the re-rupture rate of conservatively managed tendons was higher and conservative management might not be suitable for every injury depending on its severity. However, there is a clear benefit of an accelerated rehab program including early mobilization versus immobilization as has been researched by Brumann et al. (2014).

In another post, we covered what the first two weeks of rehab could look like. Having no pain at rest and no increase in swelling the patient may progress to more ankle mobility. In the second phase which can last up to three weeks, your goal should be to obtain a neutral ankle position and full plantarflexion range of motion. Make sure that the wound is healing properly and swelling continues to decrease, as well as work on restoring a normal gait pattern. You can continue to load the exercises from phase 1. But in phase 2 we are going to focus more closely on the ankle.

Exercise overview

Continue exercises with an increase in load from the acute stage which is:

• Toe flexion & extension
• Straight Leg Raise
• Clam Shells with and without resistance bands
• Side-lying abductions with or without resistance bands or ankle weights

Progress into:

• Move the ankle/foot into full plantar flexion and move back to neutral
• Ankle/foot  movement into supination and pronation (avoid dorsiflexion)
• Use resistance from a theraband for the first two exercises

In order to progress to the third stage, the patient should be pain-free at rest, achieve neutral ankle dorsiflexion and any remaining swelling or inflammation should be gone.

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If you are interested in early and  late phase rehab exercises for Achilles tendon rupture repair, check out the posts below:

• Acute Achilles Tendon Rupture Repair Rehab
• LateTendon Rupture Repair Rehab

Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture–development of an evidence-based treatment protocol. Injury. 2014 Nov 1;45(11):1782-90.

Deng S, Sun Z, Zhang C, Chen G, Li J. Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. The Journal of Foot and Ankle Surgery. 2017 Nov 1;56(6):1236-43.