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Achilles Tendon Rupture – Conservative Management

Accelerated Rehabilitation 8-week protocol

Scope of Practice

These guidelines are designed to guide physiotherapists when treating patients

following conservative management of achilles rupture using the accelerated 8-week

rebound boot protocol. These guidelines were developed by a process of systematic

review of the current evidence based literature and medical and peer consultation.

They were correct at the time of writing. The guidelines should be used in conjunction

with the clinical reasoning skills of the physiotherapist and patients should always be

treated on a case by case basis.

Literature review question

Is there any evidence to guide conservative management and rehabilitation following

Achilles tendon rupture?

Results

The previous guidelines (Version 1, 2009 and Version 2, 2013) outline that there is

limited evidence (one Randomised Control Trial) that immediate protected weight

bearing in a pneumatic walker has no detrimental effect on outcome and one

Systematic Review that specifically outlines physiotherapy management stating that

“post achilles tendon rupture, a key issue is atrophy of the gastroc-soleus complex and

difference between outcomes in early weight-bearing vs. Non weight-bearing groups in

conservatively managed Achilles tendon ruptures, and one RCT found that “plaster

casting was not found to be superior to early weight-bearing in a functional brace”

(Costa et al, 2020). Indeed these authors demonstrated that a functional brace is

therefore considered to be safe and cost effective way of conservatively managing

Achilles tendon ruptures. This supports the initial 8 week period of early weight bearing

in a Ossur Rebound boot prior to physiotherapy commencing in this guideline.

There is no current evidence recommending the ideal timescales or intensity of range

of movement, strengthening, proprioception, sports and occupation specific exercise

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comparing 2 groups. All patients in NHS Lothian that are deemed appropriate for

conservative management are either:

1. Placed in an Ossur Rebound Boot and allowed to FWB in this boot for 8 weeks.

0-4 weeks there is a 4cm wedge, 4-6 weeks there is a 2cm wedge, and 6-8

weeks there are no wedges and the ankle is in neutral in the boot. OR

2. Placed in an Ossur Rebound Boot and allowed to FWB in this boot for 8 weeks.

0-4 weeks there is a 3cm wedge, 4-6 weeks there is a 1.5cm wedge, and 6-8

weeks there are no wedges and the ankle is in neutral in the boot.

check for specific instructions.

Phase 1: Immediate Post-injury – 8 weeks (Initial Physiotherapy Out-

Patient Appointment at 8 weeks)

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 Avoid full WB stretching of tendon

 Avoid using eccentric loads which exceed the concentric ability

Phase 3: 10 weeks post injury – 12 weeks post injury

Precautions:

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Phase 5: 24 weeks post injury +

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tendon rupture was carried out. The previous guidelines were published in 2013.

These updated guidelines searched for relevant studies from 2013 to 2020. Using

NHS Scotland Knowledge Network (Web of Science) the following databases (table

1) and search terms (table 2) are listed below. These terms were based partially on the

terms used in the 2013 literature review for continuity, and modified to include other

were assessed to determine whether they were pertinent to the research question.

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Bone Joint Surg (Am) Boston: Vol 87, Iss. 10: pg 2202, 9pgs

Bibliography

Lothian Physiotherapy Orthopaedic Guidelines; Achilles Tendon Rutpture –

Conservative Management (2009)

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Appendix

† Arbitrarily, the following cut-off points have been used: large study size ≥50

patients per intervention group; moderate study size ≥30 patients per intervention

group.

*Arbitrarily, added by Lothian Physiotherapy Musculoskeletal Network Group

Version 3

Authors: Evonne Sutherland, Andrew Baxter, Mike Kennedy