G. Noel Squires
© 2015 Jason Glikman
Background and Purpose: The incidence of Achilles tendon ruptures is 1 in 10,000 per year, mostly affecting 30 to 50 year old males. These ruptures occur from either strong eccentric or concentric contractions of the gastrocnemius/soleus complex during acceleration or deceleration. Impact motions are common causes of this tendon ruptures. Neglected Achilles tendon ruptures occur when 4 weeks pass before treatment. This case report describes the clinical management of a patient with a neglected Achilles tendon rupture with global scar tissue formation due to a 3-month time period between injury and surgical repair, followed by a further 3-month time period between surgery and rehab. Literature is currently limited in suggesting the optimal treatment for this population, and this case report serves to add to the literature. Case Description: A 43-year-old male presented to physical therapy following an Achilles tendon rupture and repair. He was seen for 24 visits and underwent a manual therapy program consisting of joint mobilization of the talocrural joint, distal tibiofibular joint, and metatarsophalangeal joint, soft tissue mobilization (STM) to the triceps surae, plantar fascia, and anterior tibialis, and passive ROM of the ankle. The patient also performed strengthening and stretching exercises for the ankle over a course of 8 weeks. Strengthening exercises were progressed as the patient’s strength increased. Functional activity progress was tracked using the Lower Extremity Functional Scale (LEFS). Outcomes: The patient demonstrated improved strength and ankle joint ROM. LEFS scores improved from 36/80 at initial evaluation to 54/80 at re-evaluation. Gait pattern showed qualitative improvements following increases in great toe and ankle strength and ROM. Discussion: The findings of this case report indicate that a combination of manual therapy and strengthening and stretching exercises may yield positive results in improving a patient’s functional mobility by improving ankle joint mechanics, strength, and ROM. Future studies examining the most effective ways to mobilize scar tissue following Achilles tendon repair would be beneficial in maximizing patient function, improving functional strength, and increasing ROM.
Glikman, Jason, "The Use Of Manual Therapy And Strengthening Exercises To Improve Plantarflexion Strength And Mobility Following Achilles Tendon Repair: A Case Report" (2015). Case Report Papers. 30.