Boots or cast is used for immobilization, the ankle is kept from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down.
Ice therapy can be used to decrease inflammation and pain.
Ultrasound therapy is beneficial in the early healing process of tendons when the pulsed mode is used.
Transcutaneous electrical stimulations (TENS):
Transcutaneous electrical stimulations (TENS) are found to be effective in the healing of Achilles tendon sutures.
Laser therapy can be used in the treatment and rehabilitation of Achilles sutures alone or in combination with more conventional therapies.
Range of Motion Exercises:
Gentle range of motion exercises like passive ROM to active ROM exercises. Exercises may include Passive ankle ROM in all directions, ankle pumps, ankle active ROM in all directions, ankle alphabet. These motions should be done in a slow and in controlled way for 3 seconds, 15 repetitions up to three times a day.
Flexibility exercises are done for the ankle and lower extremity, this can help these stretch the tight muscles. The scar tissue that is formed along the injured Achilles can also help remodel the tissue and get it functioning normally, towel calf stretch, stretching for the gastrocsoleus muscles, stair stretching by hanging the heel over the edge of a step, etc. Manual stretching for the muscles surrounding the ankle can also be done. Each stretch should be held for 30 to 60 seconds and performed in 5 to 10 sets.
Progressive Ankle Strengthening:
Progressive ankle strengthening exercises are done to improve the strength of the muscles. Placing progressive stress on the Achilles tendon with strengthening exercises, helps to improve the overall function. Manual resistance, calf raises, short arc quad sets, and straight leg raise, these exercises can be done 10 to 15 times, in 2 -3.sets.
Balance and Proprioception:
Balance and proprioception impairments may develop after Achilles tendon rupture, due to the period of immobilization. Therefore specific exercises are recommended to improve the balance. E.g. single-leg stance, wobble board exercises, standing on foam, etc.
Plyometrics or high-level sports and recreational activities are also a part of the rehab program. Plyometrics are specific exercises that require to quickly jump and land in a specific and safe manner, e.g. are hopping in place, over lines, forward and backward, and side to side, first with two feet, and then with the affected foot only, etc.
The physiotherapist recommends aerobic conditioning to counteract the deleterious effects of immobilization. Aerobic exercises help to improve the strength, from non-weight bearing with minimal or no impact to full weight bearing with some impact. These exercises include biking, elliptical trainer, treadmill walking, and running.
To get the maximal effect, these exercises should be done for 30 minutes for 5 days a week. These exercises aim to return to the highest level of performance, as required by an athlete or during everyday life.