0-3 WEEKS
Precautions:
- Adjustable boot locked out at 30° of plantar flexion
- Non-weightbearing for 3 weeks — no push off or toe-touch walking
- Avoid forceful active and passive range of motion of the Achilles for 10-12 weeks
- No running, jumping, or ballistic activities for 6 months
Exercises:
- Toe curls
- Toe spreads
- Gentle foot movement in boot
- Straight leg raises
- Knee flexion/extension
- Well-leg cycling, weight training and swimming for cardiovascular conditioning
3-8 WEEKS
Precautions:
- Gradually increase weight bearing from toe-touchdown to partial as tolerated
- After 6 weeks, okay to progress to full weight bearing
- Walking orthosis adjusted 5° a week until 10° of plantar flexion
- After 8 weeks, okay to wear shoes with a heel (i.e. cowboy boots, 1/4″ heel lift in shoes)
- Avoid forceful active and passive range of motion of the Achilles
- No running, jumping, or ballistic activities
Exercises:
- Isometrics of uninvolved muscles
- Light active dorsiflexion of the ankle until gentle stretch of Achilles
- Slowly increase the intensity and ranges of isometrics of Achilles within the range of the boot
- Slowly increase passive range of motion and stretch on the Achilles after 6 weeks
- Proprioception exercises, intrinsic muscle strengthening, PNF patterns (not to Achilles)
- At 6 weeks, okay to add stationary cycling with heel push only
- Deep water workouts
- Soft tissue treatments daily
8-12 WEEKS
Precautions:
- Full weight bearing with heel lift as tolerated
- Wean into a regular shoe over a 2-4 week period
- Avoid forceful active and passive range of motion of the Achilles until 10-12 weeks post-op
- No running, jumping, or ballistic activities
Exercises:
- Gait training
- Begin and gradually increase active/resistive exercises of the Achilles
- submaximal isometrics, cautious isotonics, Theraband
- Manual full passive range of motion of the Achilles — nothing forceful
- Progress to cycling in shoe
- Swimming
3-6 MONTHS (Unless excessive fibrosis is present, should be discharged into a home program)
Precautions:
- Wean off heel lifts (if not already)
- No running, jumping, or ballistic activities until 6 month post-op
Exercises:
- Closed chain exercises – controlled slow eccentrics vs. body weight
- Controlled squats
- Lunges
- Bilateral calf raise – progress to unilateral
- Toe raises
- Cycling, VersaClimber, NordicTrack, rowing machine (gradually)
6 MONTHS
- Progress training jogging/running, jumping, and eccentric loading exercises, noncompetitive sporting activities, sports-simulated exercises
8-9 MONTHS
- Return to physically demanding sport and/or work
References: Adapted from Achilles tendon repair rehab protocol of Stone Clinic Orthopedic Surgery & Rehabilitation, San Francisco, CA
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