Achilles Repair Guidelines

Weeks 1 - 3

  • Keys - no passive DF, initiate active DF, gravity assisted PF (when incision healed), prevent wound complications
  • Patient education: use rocker boot with crutches (NWB)
  • Immobilized @ gravity equinnus
  • Gait transfer/stair training
  • Gentle scar mobs, may add heat after 2 weeks postop
  • Edema control
  • AROM (DF in seated position)
  • PROM (gravity assited PF)
  • Proximal kinetic chain strengthening (SLR, stationary cycle, intrinsic strengthening exercises, prone hamstring curls, upper body conditioning
  • GOALS: protect repai, minimize scar formation, decrease swelling
  • POD 14 - 20
  • Elbow PRE with shoulder stabilized

Weeks 4 - 6

  • KEYS: no passive DF, progress cyclic motion (active DF/gravity PF), initiate WB program
  • Scar mobs
  • Edema control
  • WB progression
    • Week 4: standing bilateral weight shift w/ towel roll under heels (no boot)
    • Week 5: standing bilateral weight sift w/ boot, progress to staggered stance weight shifting (walking progression)
    • Week 6: initiate gait in boot w/o crutches)
  • Early strengthening: submax isotonic ankle DF/PF and eversion, prone active PF with flexed knee, seated BAPS
  • GOALS: protect repair, increase PF strength, no over-stretching

Weeks 7 - 9

  • KEYS: no passive DF stretching, progress cyclic strengthening, stress plantarflexion end range strengthening, lower heel lift
  • WB training
    • Week 7: in PT - bilateral WB with sneakers and heel lifts; @ home - in boot
    • Week 8 : in PT - with skeakers and lits, @ home with sneakers and lifts, outside in boot
    • Week 9: d/c boot, but do not ambulate in bare feet)
  • AROM - DF/PF, inversion/eversion
  • Bilateral balance
  • Strengthening - T-band, end range isometrics, leg press/calf raise (week 8), 4" - 6" step-ups, swimming without fins
  • GOALS: improve fitness, moderate gastroc-soleus control, ambulate without boot
  • UBE (week 10)

IV: Weeks 9 - 12

  • KEYS: no passive DF stretching, progress cyclic muscle strengthening, stress PF end range strengthening, d/c heel lifts
  • Gait training: marching &lateral walking
  • Stairmaster
  • Retro-treadmill
  • Calf raises with eccentric lowering
  • Single leg balance (baps, decline board)
  • Steps - lateral step ups 6 - 8 inches, descend 4 inches step
  • Isokinetics (concentric, eccentric)
  • End range strengthening (bilateral decline board, prone isometric/isotonics, legg press calf raises
  • GOALS: restore normal gait, full active PF and DF
  • Continue to progress gastroc-soleus strength

IV: Weeks 13 - 20

  • KEYS: initiate passive DF stretching, progress full ROM, stress PF end range strengthening, functional training
  • Jogging and retro jogging
  • End-range PF strengthening (single limb decline board calf raise)
  • Jump progression (single leg press hopping, land on forefoot ->bilateral mini-hops -> unilateral mini-hops @ week 20)
  • Tramp hopping
  • Forawer/lateral stopovers
  • Sub-max agility training (figure-8, karaoke, shuffles)
  • Regular biking
  • GOALS: cross-over stair descent, jogging, full ROM

V: Week 20+

  • KEYS: full ROM strengthening, functional training
  • Plyometrics
  • Running/agility drills
  • Return to sport (6 months minimum, sport specific)


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