Wicker, A., Matschi, W.

Department of Physical Medicine and Rehabilitation
General Hospital of Salzburg, Austria

Inclusion criteria for non-surgical treatment:
a) Sonography: max. 5mm dehiscence of the tendon remnants at 20° of plantar flexion angle
b) Patients - prerequisites: (reliable, enough time available, symptoms)

Plan of treatment:

Phase I (1st to 7th day)
1 week plaster cast in 20° of plantar flexion angle
Walking with crutches - non-weight-bearing

Phase II (2nd to end of 6th week)
3 times a week lymph massage
6 weeks of wearing a Vario Stabil Shoe, also during night.
4th week: CPM o isokinetic system (ROM 40° - 30° of plantar flexion angle) - three times a week.
Increase of ROM 40° to neutral within 2 weeks.
5th week: Beginning with underwater exercises (gait, flexion-extension exercises of the ankle) -three times a week.
Cycling with Vario-Stabil Shoe

Phase III (7th week to 12th week)
Isokinetic exercises - plantar flexion in concentric-eccentric mode with daily adjusted progressive resistance.
Increase of ROM to 20° dorsal flexion
Normal walking with ski poles
Intensive aqua-jogger training in deep water
Cycling
Proprioceptive training (Biodex, ADAM, balance boards, etc.)

Phase IV (12th week to 20th week)
Power walking
Plyometric training
Isokinetic testing
Sport specific training
Skiing