Download Achilles Tendon Repair Rehabilitation Protocol

PHASE I

0–2 weeks

  • NWB with crutches
  • Immobilization in splint, plantar flexion

PHASE II

2–4 weeks

  • Convert to CAM walker with Achilles wedge
  • Remain NWB with crutches

4–6 weeks

  • Begin therapy at 4 weeks post op
  • Progress to 50 % WB at 4 weeks post op
  • Begin ankle ROM active dorsiflexion, passive plantarflexion
  • May remove individual Achilles wedges as motion progresses

PHASE III

6–12 weeks

  • Progress to FWB in boot at 6 weeks if incision healed
  • May wean from boot into regular shoes with heel cup after 8 weeks post op if incision completely healed
  • Restore ROM in all planes
  • May progress to isokinetics

PHASE IV:

POW 12–16

  • ROM/stretching Achilles as needed, other LE muscles
  • Gait: Ensure good gait pattern: heel–toe gait, good heel strike and push–off, stance time equal left to right
  • SLB activities (eyes open/closed, head nods, arm movement)
  • Progress to multiple planes
  • Ankle theraband
  • Begin functional strengthening exercises
  • Leg press – bilateral
  • Leg press toes raises (bilateral, progress to unilateral)
  • Progress to WB bilateral toe raises
  • Proprioception activities – i.e. BAPS, balance board
  • Hip and knee PRE’s
  • Soft tissue and joint mobes as needed
  • Stairmaster, bike for cardio
  • Ice as needed

Criteria to progress:

  • Good gait mechanics
  • ROM equal to opposite side
  • Controlled inflammation
  • No pain
  • Plantarflexor strength 4/5 (perform 10 partial to full toes raises)

PHASE V:

POW 16–20

  • Progress previous exercises: hip and knee PRE’s
  • Progress to WB unilateral heel raises
  • Stairmaster
  • Isokinetics for ankle (inv/ev, dors/pltf) – optional
  • Begin jumping progression: leg press, min–tramp, ground)
  • Functional rehab
  • Forward dips multiple plane for balance
  • Begin light plyos

Criteria to progress:

  • ROM equal to opposite side
  • Perform 20 unilateral toes raises (full range, pain–free)
  • Perform bilateral jumping in place 30 seconds each F/B, L/R with good technique

PHASE VI:

5–6 months post–op

  • Progress previous exercises
  • Progress jumping to hopping
  • Begin jogging/running when hopping is performed with good technique
  • Sport specific drills for appropriate patients
  • Criteria to discharge non–athletes:
  • Good gait pattern
  • ADL’s without difficulty
  • Gastroc/soleus 4+ – 5/5 strength

Criteria to discharge athletes:

  • Good gait pattern

Patient performs the following tests within 80% of the uninvolved leg:

  • Hop for distance
  • Single leg balance reach
  • Isokinetic strength test
  • Maintenance program should stress continued strength and endurance work at least 2–3 times per week.

*Please note: The instructions for rehabilitation protocols are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Allen or his staff should supersede the instructions above and should be followed. If you have questions regarding your rehabilitation protocol, please contact a member of our team.