Percutaneous Achilles Repair Guidelines


  • Follow up visit 5 days after surgery - remove splint, plantigrade cast placed
  • 2 week follow-up - suture removal - new cast placed
  • 4 weks postop - cast removal, boot application with heel wedges (30 deg) and initiate WBAT
  • 6 weeks postop - remove 1 wedge (re move 2nd @ 2 weeks later), continue WBAT
  • 8 weeks: follow-up, d/c boot to regular shoe
  • 12 weeks: begin isokinetic strengthening, heel raises

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

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

Weeks 20+

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


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