Penrose Physical Therapy
06
Jan 2016
Jennifer Penrose
Author
Jennifer Penrose

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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