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
- Weeks 2 – 3
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
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