Achilles Tendon Repair Protocol

ACHILLES TENDON REPAIR REHAB PROTOCOL

Phase I

Week 0 to 2

Weightbearing:

• Toe-touch with crutches while in splint or boot at all times

Rehab Goals

• Protect the wound while it heals
• Wound healing
• Minimize swelling by persistent elevation of the leg

Phase II

Weeks 2 to 4

Weightbearing:

• As tolerated but in the boot at all times
• Boot
  • Weeks 2 – 3
    • 1 – 2 ¼ inch heel lifts with foot in 10 degrees of plantar flexion
  • Weeks 3 – 4
    • Foot in 0 degrees of plantar flexion with 1 – 2 ¼ inch heel lifts

Rehab Goals:

•  Normalize gait with weight bearing as tolerated (WBAT) while in the boot 
•  Protection repair 
•  Active dorsiflexion to neutral

Exercises:

• Ankle range of motion (ROM) 
• Pain-free isometric ankle inversion, eversion, dorsiflexion and sub-max plantarflexion 
• Open chain hip and core strengthening

Phase III

Weeks 6 to 8

Weightbearing:

• Gradually wean off the boot
  • Place 1 – 2 ¼ inch heel lifts in tennis shoes for short distances
  • Gradually remove heel lifts with goal of totally removing by week 8

Exercises:

• Frontal and sagittal plane stepping drills (side step, cross-over step, grapevine step) 
• Active ankle ROM 
• Gentle gastroc/soleus stretching 
• Static balance exercises 
• Ankle strengthening with resistive tubing 
• Low velocity and partial ROM for functional movements (squat, step back, lunge) 

Phase IV

8 Weeks to 4 Months

Rehab Goals:

• Normalize gait on all surfaces without boot or heel lift 
• Single leg stand with good control for 10 seconds 
• Active ROM between 15° of dorsiflexion and 50° of plantarflexion 
• Good control and no pain with functional movements, including step up/down, squat and lunges

Exercises:

• Frontal and transverse plane agility drills 
• Active ankle ROM 
• Gastroc/soleus stretching 
• Multi-plane proprioceptive exercises – single leg stand 
• Concentric and eccentric gastroc strengthening 
• Functional movements (squat, step back, lunge) 
• Hip and core strengthening

Phase V:

After 4 Months

Rehab Goals:

• Able to perform sport-related movements with control and pain-free

Exercises:

• Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to other and then 1 foot to same foot 
• Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities 
• Sport/work specific balance and proprioceptive drills