Ankle > Achilles Tendon Rupture > Treatments

   Casting

Treatment Introduction

When conservative treatment of your Achilles tendon rupture is prescribed, you typically have your ankle immobilized in a short leg cast for about six weeks. Non-surgical treatment is most successful when started within 48 hours of the injury. Most of the time, the cast is applied in your physician's office immediately after the diagnosis is made. You usually are instructed to use crutches and not bear weight on your ankle while wearing the cast.

   A short leg cast wraps around your foot, ankle, and lower leg; it starts below your knee and is open around your toes to allow toe movement.

   Short leg casts typically are made of layers of fiberglass. Your physician usually rolls a thin elastic stocking, called a stockinette, over your skin, and cast padding is placed around your foot and ankle.

   A dry layer of fiberglass is then wrapped around your leg and foot. Extra fiberglass strips are wrapped around the sole of your foot. Additional fiberglass layers are applied wet over the first layer.

   When the short leg cast dries, it should immobilize your ankle but allow you to move your toes. It should be snug, but not tight.

Your foot usually is put into the cast in a slightly bent downward position, called gravity plantar flexion. This is the natural position of your foot hanging down with the force of gravity. Physicians sometimes order MRI (magnetic resonance imaging) after your cast is applied to check to see if the two ends of the ruptured tendon are aligned correctly. Over the course of six weeks, you go back to your physician for new casts until your foot is brought up to a neutral position, in which your ankle is not bent. Though every physician has a slightly different way of treating Achilles tendon ruptures in a cast, the general schedule is as follows:

   Two weeks - Return to your physician for a new cast that immobilizes your foot in a less bent-downward position.

   Two to four weeks - Your physician may bring your foot up to a neutral position in either a walking cast or brace, called a cam walker, and you usually can begin bearing some weight on your ankle.

   Six weeks - Begin wearing a cam walker or supportive shoes with an orthotic heel lift, and begin bearing more weight on your ankle.

You should always keep your cast dry when recovering from an Achilles tendon rupture. Your physician can show you how to wrap plastic around it while showering, or you may be able to bathe with your lower leg out of the tub. Physicians generally recommend that you avoid bearing weight until your tendon has healed. Crutches are usually prescribed for about four to six weeks after an Achilles tendon rupture. In general, you can begin some weight on your ankle when you are put into a walking cast or cam walker sometime between two and four weeks after the initial cast is applied. You may find it difficult to use crutches, but it is essential to keep as much weight as possible off your ankle for the first few weeks. The more weight you put on your ankle, the greater your chances of straining your healing Achilles tendon tissue. Household tasks that require you to be on your feet may be difficult for several weeks. It can be helpful to have someone around the house who can help with any physical chores. Your physician may prescribe range of motion exercises for you to perform at home after your cast is removed. The goal is to avoid pain and stimulate blood flow and circulation. Patients generally are instructed to remove their ankle brace for a brief period and prop their lower leg on a stool or pillow so your ankle is off the floor. Physicians generally recommend moving your ankle up, down, and side-to-side. Start with slow movements and do not move your ankle too far in any direction. When the cast comes off, you should not feel pain, but your ankle will likely feel weak and stiff. Movement and walking may be awkward at first. Because of the risk of re-rupture when you have not had surgery, your physician generally evaluates your ankle after six weeks and often refers you to a physical therapist, who can supervise your progress and test your tendon strength.

The recovery period after a ruptured Achilles tendon usually lasts for many months. Without surgery, your tendon may lose some of its original strength and your physical therapist can help determine what activities are safe for you. You typically progress from range of motion exercises, to light cardiovascular exercise, and then strengthening exercises. If you experience episodes of minor swelling or pain while exercising, have your physician examine your ankle. Physical therapy usually involves learning an ankle stretching routine and performing foot and lower leg strengthening exercises. The following ankle stretching exercises are commonly prescribed:

   Ankle stretching exercises

   Ankle strengthening exercises

Prevention

Avoiding another rupture of your Achilles tendon usually requires caution during sports and activities. Patients who receive conservative treatment for their ruptured Achilles are at a higher risk of re-injury, but usually these patients are older and are not trying to return to competitive athletics that put heavy strain on their Achilles tendon. Sports that require quick starts and stops, sprinting, and jumping may increase your risk of re-injuring your Achilles tendon. Incorporating cross-training into your workout schedule can be helpful. For example, instead of running every day, alternate between running and swimming workouts. Warm up before participating in activities and stretch your calf muscles, Achilles tendons, and feet both before and after activities. You should increase the duration and intensity of your workouts by no more than 10 percent per week and avoid serious sprinting and hill climbing unless you have worked up to a high fitness level and you have talked with your physician. Choose athletic shoes that properly fit the shape of your foot. Continue to wear orthotic inserts and heel lifts if recommended by your physician. If your ankle starts to hurt during exercise, you should return to your physician’s office for a check-up.