Haglund's Lesion Resection and Achilles Tendon Reattachment - Rehabilitation Protocol:
Phase 1- Weeks 1-2:
Physiotherapy goals:
- Maintain independent ambulation
- Pain and oedema control
- Protection of operated foot in a short-leg non-weight-bearing cast in a plantarflexed position
Interventions:
- Patient discharged from hospital in a below-knee plaster of Paris backslab
- Mobilisation with crutches, non-weight-bearing for 2 weeks
- Encouraged to maintain limb elevation for “55 minutes in the hour”
- Attend clinic no later than 2 weeks for removal of sutures and removal of cast
Phase 2- Weeks 2-12:
Physiotherapy goals:
- Protection of healing tissues in a Vacoped walker boot
- Progressive weight-bearing: Post-op weeks 2-6 Vacoped locked at 30º plantarflexion, Post-op weeks 6-8 Vacoped locked at 15-30º plantarflexion
- Aim to be plantigrade by 8 weeks and weight bear in unlocked Vacoped 0º ankle dorsiflexion with flat-sole attachment
- Achilles tendon active plantarflexion exercises without resistance
- Pain and oedema control
Precautions:
- No strength training/activation against resistance of Achilles tendon until week 10
- No ankle dorsiflexion beyond neutral until at least 12 weeks post-op.
- Avoid prolonged walking and standing
Interventions:
- Progressive weight-bearing in the Vacoped
- Pain and oedema control with ultrasound/cryotherapy/deep tissue massage
- Activate other muscle groups without stretching the Achilles tendon
- Hydrotherapy
Phase 3- 12-16 weeks:
Physiotherapy goals:
- Transition from Vacoped to a trainer with a heel lift from week 12-14
- May still need Vacoped for outdoor protection
- Restore 4-5/5 power in all muscle groups including the Achilles tendon by 6 months
Interventions:
- Gait training, proprioception and forefoot intrinsic strengthening
- Resisted active ROM exercises from 10 weeks using Therabands
- Cycling on exercise bike from week 12, Stairmaster from 16 weeks
- Commence double and then single heel raises from 16 weeks
- Controlled Gastroc/soleus stretching from 14 weeks
Phase 4- 4-6 months +:
Physiotherapy goals:
- Patient to increase level of activity independently- avoiding exercise leading to excessive ankle dorsiflexion (soft ground running etc.)
- Able to undertake and maintain a single heel raise stance
- Return to contact sport after 6 months if appropriate
Interventions:
- Increase strengthening of all muscle groups against resistance
- Leg-press from 6 months
- Commence jogging, running, stair climbing
- Proprioceptive drills and forefoot intrinsic strengthening to continue
