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.
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 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 often
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.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
You should always keep your cast dry. 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. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
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 stretching
exercises are commonly prescribed:
Avoiding re-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-rupture, 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-rupture. Try to incorporate
cross-training into your workout schedule. 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. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
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 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.
