The tendons twist from proximal to distal as they insert into the calcaneous, creating a shearing force. PDF Non-Operative Treatment of Achilles Tendon Rupture <> The guiding principle for this rehabilitation protocol is early ankle motion, since it is believed to be the main reason why surgically treated Achilles tendon ruptures show a lesser rate of recurrence than those treated conservatively with a period of immobilization. It is found at the back of the lower leg, just above the heel bone. Touch weight ?h{vV4ECHD+A?E_Q-9U1DJY;p9 I* XX%|EjbwJH(g0Nf5.I ;v$c7H(d a_2d6QN&m Insulin-like growth factor binding protein 4 loaded electrospun Zhang Z, Li Y, Zhang T, Shi M, Song X, Yang S, Liu H, Zhang M, Cui Q, Li Z. etc until cleared by The goal of surgery is to reapproximate the ruptured tendon ends in order to promote healing and restore overall strength. Procedure: Conservative Management of Tendo-Achilles Rupture - Accelerated 8-week protocol Indications for Procedure: Tendo-Achilles Rupture Expected Length of Stay: n/a Surgeons: All orthopaedic trauma surgeons Scope of Practice These guidelines are designed to guide physiotherapists when treating patients following conservative management . The Achilles tendon, which is about 12-15 cm long and comprises both the gastrocnemius and the soleus tendons, is the thickest, strongest and largest tendon in the human body. Epub 2020 Dec 17. 2 0 obj s% i5iYd}mYSz;0Wj|*:2aO5ZmJeNWhqLx* EUgm"5l94`0;C1B]@-yH?0{2ER'fL-j6U,@tyS]?sZn|(E31-*=} Tripping, falling or twisting your ankle can also cause an Achilles tear. The Efficacy of Different Rehabilitation Protocols After Achilles Injury2014;45(11):1782-1790. Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis. Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence. Morimoto S, Iseki T, Nakayama H, Shimomura K, Nishikawa T, Nakamura N, Tachibana T. Regen Ther. Goals: Protection of repair and achieve active dorsiflexion (DF) to neutral. Slowly wean from boot. J Sci Med Sport. York (UK): Centre for Reviews and Dissemination (UK); 1995-. #WDA E=wNh|3Ln]8iwGuxfws7xl+|Y0~Pu 5 0 obj Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. postop. Achilles Tendon Rupture: Symptoms, Treatment, Recovery | HSS Normalize gait on all surfaces without boot or heel lift. VQ4 L}3Sz~zzDM>{z?NO?UI(/oO=:0QI]WrDctQa4TxR6=&eA>F2z>'%62p2{c86Y82b%q}`D U4x$!fGjGg$grJ,l6hqs&Sn5?1qX:{6G|8(?Mu83V\kZO._C9=7R4z-XW3"tcFWPoJ^&K.HfZ5E.LJSe=jC7S'r++@7Tka'k{e1u_X\W{Rv3x:gj. [PDF] Accelerated rehabilitation following Achilles tendon repair after of direction, jumping He was able to ambulate without assistive devices at the 5-week follow-up examination. Front Cell Dev Biol. weight) Emerg Med Int. Continue hip and building to It attaches your two calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus) and helps you go up onto tiptoes. Functional movements (squats, step backs, lunges). Unable to load your collection due to an error, Unable to load your delegates due to an error. Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon. Higher level proprioception Copyright 2014 Elsevier Ltd. All rights reserved. Single leg stance with good control for 10 seconds. ACCELERATED ACHILLES PROTOCOL Time Frame Activity . Post-op weeks 3-4: boot at 10 degrees, sleep in boot, TTWB with crutches. BMC Musculoskelet Disord. 2) Tendon shearing forces can rupture the Achilles. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. Brumann M, Baumbach SF, Mutschler W, Polzer H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-development of an evidence-based treatment protocol. Progression of calf stretching past plantar grade. 2007 Nov 6;8:108. doi: 10.1186/1471-2474-8-108. The site is secure. stream Accessibility Multiple surgical and nonsurgical approaches to treatment exist, 28 and the superiority of one over the other remains controversial and depends on patient factors and preferences. Begin standing calf stretch at 5 weeks (knee flexed and extended) Continue eversion, inversion and plantar flexion isometrics with resistance bands. 2011 Dec;17(4):211-7 We mostly see ruptures of the Achilles tendon in high-impact sports predominantly in the male athlete. Unauthorized use of these marks is strictly prohibited. endobj Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. Ruptures of the tendo achillis. National Library of Medicine -, Am J Sports Med. hbbd```b``"Z@$"d8XDI90L~_DH`U&(H( X$D I]@k"_ 6' Orthop J Sports Med. SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. 2 0 obj Goals: PT appointments are once every one to two weeks. A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles An insight is given into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP to give an insight into the course of recovery after ATRs. NCI CPTC Antibody Characterization Program, Foot Ankle Surg. Walking). Achilles Tendon Repair Rehabilitation Protocol | Stony Brook Medicine Careers. In an acute Achilles Tendon Rupture, there are two options: Surgical repair with accelerated rehab protocol. 0 Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol. 1,2 These reviews and other systematic reviews consistently show a slightly lower incidence of re-rupture with operative treatment, which is . endobj Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. 4 However, this . CAMBOOT with 20mm heel lift or VACOPED (2) and wedge sole for 3rd week. Plaster Cast or CAMBOOT with 30mm heel lift or VACOPED (3) plus wedge sole for 1st week. A potentially more accelerated rehabilitation and return to activity; Tendon healing with optimal end to end re-attachment, hence restoring Calf muscle-Achilles anatomy with minimal scar tissue bridging. -, Am J Sports Med. Achilles Tendon rupture: Post Surgery actions and recovery protocols and concerns. 3 0 obj Ankle strengthening concentric and eccentric gastroc strengthening. ;ce%.WRu|^hR95eUmSkTusie\O~_TM6LoD,J/L-Y.Wjqw rU/>un+83ZI&|QUqsr7iWUJ/z\fv j7tvM bmmQ4Lz6kS2 K!bTFql:wGA?j)af/ \e9&Rx:V'mWJH~#u]2ZV=.7`yI10oRk 5sJ~bP[+;Ta;|r aQVJ~^%|8gd~YPnY@L}db'\2%k_ b7mQI00}yS$g7%i$wKfa58k&JV$ \&I[Z%sVl8= PMC IRh3J@+ZR*RNE+Ni$Gg3) x):+!#$SEL*u:Jd4r Achilles tendon rupture is a clinical diagnosis. endobj The achilles tendon accounts for 20% of all large tendon injuries 1 with an estimated incidence ranging from 11 to 37 per 100,000. #-K@E56sw wno6@gpMR NBg)A)K)m"zE>N_of J1&c. Keywords: Achilles Tendon Rupture Accelerated Rehab Protocol PDF | PDF Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. . 2003 Jun;54(6):1171-80; discussion 1180-1. doi: 10.1097/01.TA.0000047945.20863.A2. Everything went well, had the staples removed yesterday. Lightsey HM, Noback PC, Caldwell JE, Trofa DP, Greisberg JK, Vosseller JT. Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? 2022 Aug 19;2022:2363230. doi: 10.1155/2022/2363230. 1.Introduction. Achilles Tendon Rupture - Non-operative treatment rehabilitation This acute (sudden) injury occurs when the tendon stretches to its breaking point. A rupture of the Achilles Tendon (ATR) is a common pathology being the most commonly ruptured tendon in the human body. Consequently, physicians may have reservations about adopting functional rehabilitation. 1990 Mar;18(2):188-95. Tendon is a specialized tissue mainly composed of collagen extracellular matrix (ECM), transmitting forces from muscle to bone [1].Tendon injury accounts for a large proportion of musculoskeletal system disorders and poses a substantial burden on human health [2].Therapeutic interventions including surgery, drug, physical therapy and rehabilitation are used for tendon repair [3]. Gentle calf stretching with a towel (not body weight). Detailed Description: Open navigation menu. FOIA Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. 204 0 obj <>/Filter/FlateDecode/ID[<5F38DF44F3FF7641895593BD7106A5BB>]/Index[179 50]/Info 178 0 R/Length 115/Prev 119698/Root 180 0 R/Size 229/Type/XRef/W[1 3 1]>>stream V.&!Na 1"}2C1[irXd8`<9f4X|(iTerx_&>uQMAv/>My]Zg}?;fl|Hpt. Achilles Tendon Repair Rehab Protocol - manhattansportsdoc.com Seven studies were included. en Change Language. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with tendon augmentation, re-rupture after non-surgical management, revision, chronic tendinosis, and co-morbidities, for example, obesity, older age, and steroid use. <>>> . Epub 2015 Sep 26. <> Open Achilles Tendon Rerupture: A Case Report and Review of - Hindawi Foot Ankle Spec. Bethesda, MD 20894, Web Policies <> of the Achilles tear and repair. Acute 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. % Calf muscle rehabilitation post Achilles tendon rupture bearing xwn $8sxkL=. *MoaoLzhN:fOad)t-h96.&JxEys4JUy-nEu  Unable to load your collection due to an error, Unable to load your delegates due to an error. Achilles tendon rupture - Symptoms and causes - Mayo Clinic This combination was most beneficial. MeSH Brumann, M., Baumbach, S. F., Mutschler, W., & Polzer, H. Accelerated rehabilitation following Achilles tendon repair after acute rupture-Development of an evidence-based treatment protocol. Injury. Hi folks, I am in week three post full Achilles rupture repair surgery. Y!_x"o7/_"H4IE(:}/1 Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion. x\*"S&Rd9l)+%\hwMROw3$\Z1~v/^x|m],^}3fdY7iTe*)XU6ugshO_KQ`F5vYU? PDF ACCELERATED ACHILLES PROTOCOL - Indiana Total Therapy Cardiovascular: stationary bike, StairMaster, swimming. %PDF-1.7 Chronologic Changes in the Elastic Modulus of a Healing Achilles Tendon Metz R, Kerkhoffs GM, Verleisdonk EJ, van der Heijden GJ. < Unauthorized use of these marks is strictly prohibited. Accelerated Rehab Program | Mr Daniel Goldbloom | Melbourne endstream endobj 180 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 177 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 181 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 182 0 obj <>stream endobj Massen FK, Shoap S, Vosseller JT, Fan W, Usseglio J, Boecker W, Baumbach SF, Polzer H. EFORT Open Rev. Accelerated rehabilitation following Achilles tendon repair after acute rupture development of an evidence-based treatment protocol. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Good control and no pain with sport/work-specific movements, including the impact. Accelerated rehabilitation; Achilles tendon rupture; Minimal invasive repair. PoT"u+: Low level calf plyometric exercises (fast CRs, tip toe . Place heel raises (1-2cm) in shoes to take some of the pressure off the Achilles tendon. 12 weeks with supervision (double This protocol was updated and reviewed by Dr. Devries and Dr. Scharer of BayCare Foot & Ankle Center and by Jessica Sigl, DPT on . /n%^xij_2]!J] n >!UGld Continue resisted inversion and eversion through range, Double leg stance out of boot; single leg stand in boot progressing to out of boot as balance improves. CAMBOOT with no heel lift or VACOPED at (0) with flat sole. Good control and no pain with functional movements, including step-up/down, squats and lunges. View a complete list of our locations and hours. Achilles Tendon Ruptures are common tendon injuries that occur due to sudden dorsiflexion of a plantarflexed foot, most commonly associated with sporting events. A Closer Look At A New Protocol To Manage Achilles Tendon Rupture The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. <>/Metadata 358 0 R/ViewerPreferences 359 0 R>> The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. 2021 Jun;24(6):536-543. doi: 10.1016/j.jsams.2020.12.005. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. Introduction Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. close menu This site needs JavaScript to work properly. Can commence light isometric calf exercises at low resistance and reps, not past plantar grade. PDF Standard of Care: Achilles Tendinopathy - Brigham and Women's Hospital weight II. eCollection 2021 Dec. Hidd SMCM, Tim CR, Dutra EF Jr, Maia Filho ALM, Assis L, Ferreira RS Jr, Barraviera B, Silva JF, Amaral MM. 3 0 obj Normalize gait on level surfaces without boot or heel lift. Accelerated rehabilitation following Achilles tendon repair after acute Operative versus non-operative treatment of acute Achilles tendon ruptures: a multi-center randomized trial using accelerated functional rehabilitation. Continue active resisted theraband exercises; plantarflex through full range, dorsiflexion to a natural plantigrade position, push no further. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. Achilles Tendon Injuries | Johns Hopkins Medicine eCollection 2022. Dynamic neuromuscular control with multi-plane activities, without pain or swelling. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. endobj Bethesda, MD 20894, Web Policies Achilles tendon rupture is a common sports injury encountered in younger populations. Results: Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. Acta Cir Bras. Plaster Cast or CAMBOOT with 20mm heel lift or VACOPED (2) plus wedge sole for 2nd week. Hi folks, I am in week three post full Achilles rupture repair surgery. Active ROM between 15 degrees of DF and 50 degrees of PF. %PDF-1.5 2011 Apr;39(4):820-4 jumping, running. It is important to evaluate whether early functional weight-bearing . !.XyR-Kd-+"v+l3,~l|LR {Z^R}TTKS`p*9szqAdJAs2QGE6pzHf)'a n7=pMi-Sn3r7$5B"yUMQy^&hkj)V&a55JZp5JSb^]"37H919=N]?&h6.M{Af[Uf`0R;DW x^Q^5fu;%)Ptu$DtqEHg Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. Westin et al. Postoperative rehabilitation protocols for Achilles tendon ruptures: a 8600 Rockville Pike Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Achilles Tendon Rupture: Mechanisms of Injury, Principles of It mainly occurs in people playing recreational sports, but it can happen to anyone. Achilles Tendon rupture: Post Surgery actions and recovery protocols Conclusion: Acute Achilles Tendon Rupture Repair Rehab | Early Rehab Exercises ,8vue6Tq]6u06glk+zBE)wY4DNmJM4Y >I>UB5|g`dd?#ap_N#r*cCQm5&tcH_~vw~DXOI)J,!u 2017 Mar;137(3):333-340. doi: 10.1007/s00402-017-2627-9. Achilles tendon rupture; Ankle mobilization; Evidence-based; Functional treatment; Immobilization; Rehabilitation; Surgical repair; Treatment protocol; Weight bearing. Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. doi: 10.1590/ACB360407. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0 should be applied. Cont. It is rare to have this procedure immediately after going to the emergency room for an injury. Sport/work-specific balance and proprioceptive drills. PDF Non%operative!Treatment!for!Achilles!Tendon!Ruptures! Disadvantages. 4 0 obj Nonoperative or Surgical Treatment of Acute Achilles' Tendon Rupture Active ankle eversion/inversion. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. scar mobilization and friction massage) to decrease fibrosis. 179 0 obj <> endobj Pull your toes upwards to stretch the Achilles tendon. Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. Blood Flow Restriction Training After Achilles Tendon Rupture 2018 Mar;26(3):846-853. doi: 10.1007/s00167-015-3795-1. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. Torn Achilles Rehabilitation - Following Surgery and Non Surgical Achilles Tendon Rupture - Non-operative treatment rehabilitation guidelines 0-2 WEEKS REST (PHASE 1) Goals Rest, recovery and mobilise non-weight bearing safely on crutches Immobilisation Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed) For best outcomes, the Achilles tendon repair is typically performed within 2 weeks of the injury and recovery is expected to take between 6 to 9 months. 1 0 obj It connects the muscles of your calf to your heel. Patient must be willing to comply with the functional rehab protocol and strict guidelines. Epub 2018 Jan 8. 3,10,13,25 Historically, surgical repair of Achilles tendon rupture was thought to decrease the risk of re-rupture substantially. Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. An Achilles tendon rupture is a full or partial tear of the Achilles tendon. Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. 2022 Oct 14;19(20):13254. doi: 10.3390/ijerph192013254. With!weighted!resisted . The https:// ensures that you are connecting to the Ruptured Achilles: How to Recover From Achilles Tendon Injury - WebMD The length of the incision and the surgical approach will depend on location of the rupture. Normal gait mechanics without the boot on all surfaces. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Impact control exercises beginning with two feet to two feet, progressing from one foot to the other, and then one foot to the same foot. high load ankle, knee, hip Post-activity soreness should resolve within 24 hours. PDF ACHILLES RUPTURE: OPERATIVE PROTOCOL - South Bend Orthopaedic Associates Moderate load plyometrics at Goals: Achilles Tendon Repair Rehabilitation Protocol, North Fork Orthopaedic and Sports Medicine, Lower Extremity Fracture Care Post-Op Instructions. endobj 3{pn04,NMi"]C@C!r-\8yJY cMylwJ nOVn:K"ldCsseC! %PDF-1.5 % Achilles Tendinopathy Treatment & Rehab Protocol - Dublin Sports Injury 2014. Accelerated rehabilitation following Achilles tendon repair after acute Immediate full weightbearing and ankle motion exercise after repair of acute Achilles tendon rupture can provide a good rehabilitation option with a low re-rupture rate and satisfactory functional results. No study found an increased rerupture rate for the more progressive treatment. The exercises stretch your Achilles tendon in ways that help it handle forces and stress better. HHS Vulnerability Disclosure, Help ,dDu=hQ*S:m6 _0}NTD4%Dw $k7pQ(@Wi:s.K^ Federal government websites often end in .gov or .mil. Using Long-Duration Static Stretch Training to Counteract Strength and Flexibility Deficits in Moderately Trained Participants. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. endobj Treatments are chosen based on the size of the tendon defect. The body then heals the tendon in the appropriate position. An official website of the United States government. Frontal and transverse plane agility drills (progress from low velocity to high, then gradually add in sagittal plane drills). independently). Physiotherapy Tailored and monitored by physio, Achilles Tendon Rupture Non-operative treatment rehabilitation guidelines, Achilles Tendon Rupture Operative treatment rehabilitation guidelines, Achilles Tendon Rupture Rehabilitation Videos, Big Toe (Hallux) 1st MTP Joint Fusion Surgery, General Information about Foot and Ankle Arthroscopy, General Information Injuries and Fractures, National Guidance Documents for Foot Surgery, Rest, recovery and mobilise non-weight bearing safely on crutches, Plaster cast/Rigid boot with foot pointing downwards 20 (with 3 wedges inside - 22/16/10, more if needed), Can carefully shower with waterproof cover over plaster cast/boot, Confidently weight bearing as pain allows using the crutches, Begin early, supervised, gentle ankle plantarflexion exercises, Maintain core, upper limb, hip, and knee strength, Rigid walking boot with foot pointing downwards with wedges inside boot, Can shower out of boot as long as very careful not to stand/stumble on foot, otherwise leave boot on with waterproof covering, Can weight-bear with crutches as discomfort allows in boot, Maintain spinal/hip/knee/toe range of movement, Can remove boot for exercises to gently actively plantarflex foot from position in boot to full range plantarflexion, Can dorsiflex back to position in the boot but not beyond, Progress to fully weight bearing but maintain use of crutches for balance if needed, Active ankle movement through available range of plantarflexion from position foot held in boot, Regain full inversion and eversion in available plantarflexion range, Aim for ankle plantigrade/foot flat by6-8 weeks in boot, Rigid walking boot with wedges being removed weekly to plantigrade position, Can remove one wedge per week until foot flat in the boot, Can perform active resisted plantarflexion, eversion and inversion with theraband, Can actively dorsiflex foot ONLY to position allowed by wedges in boot, No knee hyperextension to compensate for lack of ankle dorsiflexion, Aim to remove boot by weaning out by 12 weeks, Increase ankle and lower limb muscle strength, Boot with ankle plantigrade/ foot flat on the ground, Shower carefully so as not to stumble/forcefully dorsiflex ankle. group 2-4 weeks Aircast walking boot with 2-cm heel lift* Protected weight-bearing with crutches [PubMed: 25059505]. OJSM 2016 2. Careers. (open!andclosed!kinetic!chainas!well!as!functional activities)-!start!withTheraband!tubingexercises! Very gently at first and gradually build up . Our rehab protocols outline timing, precautions and progression criteria for returning to activity. ':IU""e"E/JT?|OW:_Yn]n7buq}].moS_7xbU]}\o/|`ND^QTK/EnTYJ=U6~U1 2 0 obj Online Physical Therapy Protocol Quality, Variability, and Availability in Achilles Tendon Repair. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. 2014 2. Wilkins R, Bisson Lj. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Active stretching. 2022 Oct 26;7(10):680-691. doi: 10.1530/EOR-22-0072. Squat to 30 degrees knee flexion without weight shift. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. Willits K, Amendola A, Bryant D, Mohtadi NG, Giffin JR, Fowler P, Kean CO, Kirkley A. J Bone Joint Surg Am. Current Updates in the Treatment of Achilles Tendon Rupture Must be a complete, mid-substance Achilles tendon rupture & not a tendon avulsion from the calcaneus or gastroc/soleus. Copyright 2014 Elsevier Ltd. All rights reserved. Cardiovascular: Upper body circuit training, Physical therapy appointments begin one to two visits per week.