Strategies for rehab after Achilles tendon surgery

Below is another excellent article on the above that is a bit technical but which I found very informative, especially the charts. Bonne chance!

http://lowerextremityreview.com/article/strategies-for-rehab-after-achilles-tendon-surgery

4 Responses to “Strategies for rehab after Achilles tendon surgery”

  1. Interesting article. It’s good to see clinicians trying to be evidence-based (for a change!). A coupla things jumped off the page for me:
    1) “In a 2008 study of 219 Achilles tendon surgeries, we found that suture granulomas can occur in a delayed fashion and that, overall, 7.3% of patients experienced wound complications.24″ Yee-yikes! These wound complications are not the only complications that are more common post-op than non-op, either! This suggests that the anecdotal experience here — of quite a few post-op patients suffering — may not be as non-random a sample as many of us hoped.
    2) Around here, we’ve only noticed ONE study that went too fast and produced inferior results (op & non-op both). The rest have produced better the results the faster they go, through UWO and the more recent UK (Exeter?) study. But these folks have convinced themselves that a bit slower may be optimal for many patients.
    3) One specific exercise group — ECCENTRIC calf & AT exercise, like “two up, one down — is a BAD THING for quite a while post-op, accd to their read of the evidence!! They advise avoiding it until AFTER mastering CONcentric, like 1-leg heel raises! A bunch of us hereabouts have been recommending the opposite, including me!
    4) Like the ultra-conservative surgeon who fixed my first ATR 12 years ago, they oppose sports return until you can do a bunch of good 1LHRs. I still can’t do that with my ATR #2 leg, but I’ve been kicking butt in competitive volleyball (beach & court), no problem, so this seems nuts to me.
    5) The Alter-G treadmill seems nifty, though exercising in a pool could do the same.
    6) this is the first time I’ve seen an evidence-based attempt to link rehab protocols to specific surgeries — though the sample sizes are pretty small. But they suggest that tendon transfer ops should go slower than others (& than non-op, apparently), and delayed/chronic ops, too. And simple ops that don’t sever or reattach the AT (like debridements) can go much faster. The latter is no surprise, but maybe the former is (if true).

  2. And (7): They give a huge endorement of INCREMENTALISM in their schedule of heel raises!

  3. More on Exeter, for those fairly new here.

    The orthopaedic team there analysed the data on the ATR patients treated at the Royal Devon & Exeter Hospital (NHS Foundation Trust) from October 2008 to March 2012. There were 246 patients during that time, of which 98 were treated surgically and 144 were treated ‘conservatively’ (some were partial ruptures). 4 didn’t follow through.

    Three of the non-op patients (1.2%) re-ruptured and two surgical cases (2%) suffered wound issues. Two patients (one op, one non-op) had clots.

    The team used the Vacoped boot with its custom accelerated rehab programme including dedicated physiotherapy clinics to produce the results above.

    I was fortunate to have been one of the non-op cases, and now, almost 2 years later my leg is back to normal. My pastimes include hill and mountain walking, and some pretty heavy duty garden and tree work.

    I put a lot more information on Suddsy’s blog a few months ago which importantly detailed the actual rehab protocol from both Exeter and Suddsy’s medical people (also UK but Suddsy was surgical). I began weight bearing as tolerable after week 2 and pretty well dispensed with the crutches (elbow type) by week 3 or 4. ‘2 shoes’ happens at week 8/9, and safe driving soon after. Then you simply follow the rules (!) and get lots more physiotherapy, really ramping up at about week 16+.

    I’ll try to find the relevant URLs but dinner calls now.

  4. Exeter, etc….

    http://achillesblog.com/suddsy/2013/06/24/end-of-wk-2-wow-progress/

    includes other links including Exeter.

    Suddsy - how are you doing? Thanks for letting me hijack your blog again…

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