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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