Post Operative Protocol- Achilles Tendon Rupture Repair 

What to Expect after Achilles Tendon Surgery
Post Operative Protocol
Before Surgery
Medical Clearance and Pre-operative Blood work
Schedule Time and Date for Surgery
-Most patients elects to receive an Popliteal Nerve Block; This is were Local anesthetic medication is delivered directly around the nerve that supplies sensation to your foot and ankle. This helps a great deal with pain after surgery
Immediately After Surgery
You will be in a splint with your foot plantarflexed (pointed to the ground), this will keep the tension off the Achilles tendon. This splint has to stay on until the first post operative visit.
The patient must be non weight bearing and keep the splint clean and dry. This means using a cast or shower bag to keep the surgical area dry.
Ice behind the knee(the splint will prevent direct ice to the surgical site), this cools the blood traveling down to the surgical site.
Be sure to move your knee. Being sedentary and lack of ankle and knee mobility increases your chance of a blood clot or DVT particularly when the Achilles tendon and calf muscle are involved. Signs of a DVT are calf pain, tightness and warmth.
2 weeks post op
The splint is removed.
Sutures and/or staples are removed.
Often times I will keep the patient immobilized until the 3 week mark to ensure adequate skin and tendon healing.
3 weeks
The patient is transitioned into a removable Boot with heel wedges (to keep the foot plantarflexed) and can begin active plantarflexion(gas pedal exercises, NO stretching of the Achilles, STRENGTH only).Physical Therapy can be started at this point.
The patient can now get the surgical site wet.
-Every week or two (depending on heel lift size) a heel lift is removed until the patients foot is flat around the 8 week mark post op.
6 weeks post op
The patient can begin standing loaded strengthening exercises. Still, no stretching, and working solely on strength of the calf and achilles in a controlled fashion.
8 weeks-10 weeks post op
Transition from a boot to a shoe.
-PT is progressing from non weightbearing, to static to dynamic activity from the 2 week for 12 week mark post operatively.
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