KINESIOTHERAPEUTIC APPROACH TO ACHILLES TENDON RUPTURE - PRESENTATION OF A CLINICAL CASE

Abstract

Modern methods of treatment for traumatic injury to the Achilles tendon include surgical and non-surgical procedures.  Regardless of the treatment strategy, Achilles tendon rupture leads to significant functional impairment and therefore the kinesitherapy protocol is an integral part of restoring the patient's pre-trauma activity level.

The aim of this article is to familiarize the audience with the effect of a kinesiotherapeutic program on a patient with Achilles tendon rupture.

Patient presentation. I present a clinical case of a 71-year-old patient with Achilles tendon rupture against a background of chronic inflammation lasting more than three months. Due to the lack of timely referral to rehabilitation after surgery, several months later, a worsening of motor deficits was observed. Upon assessment of rehabilitation potential, limited ankle mobility and muscle hypotrophy of the lower leg were observed, with the most pronounced deficits in the triceps surae muscle. Difficult gait with shortened support phase of the right lower limb was recorded.

Goals, tasks, and means of kinesitherapy. Based on the rehabilitation potential, the goal of kinesitherapy is to restore the supporting function of the right lower limb in order to achieve stability, security, and greater independence for the patient in daily activities.

The tasks of kinesitherapy related to the established deficit refer to  increasing  the range of motion of the ankle joint, restoring the elasticity of the Achilles tendon, restoring the normal accessory mobility of the foot complex, gradually increasing the load on the limb in order to restore the strength and endurance of the muscles of the lower leg and foot with a view to improving gait parameters.

The kinesiotherapeutic methods include massage of the lower limb, manual inhibition techniques on the ankle joint and foot, closed kinetic chain mobilization, exercises to improve the trophism of the foot muscles and strengthen the muscles of the lower leg and foot, exercises for flat feet, balance and postural control training, and gait training.

Results. After a 10-day course, ankle joint mobility improved, muscle strength in the measured calf and foot muscles increased, proprioception, coordination, and balance improved through the application of closed kinetic chain exercises and exercises on unstable support, with a view to integrated restoration of neuromuscular control and prevention of recurrent injuries. One of the most effective methods for improving dynamic stabilization, balance control, and ankle function is proprioceptive training, which contributed to improved gait on level ground as well as stability when climbing and descending stairs.

Conclusion. Following kinesiotherapeutic treatment, the patient exhibited notable improvements in the functional status of the right lower limb. Assessment results indicated an enhanced range of motion in the ankle joint, alongside increased muscle strength and endurance in the primary muscle groups responsible for joint stabilization and movement. These advancements positively influenced the patient's gait, balance, and overall motor activity.