physiotherapist doctor rehabilitation consulting physiotherapy giving exercising leg treatment with patient in physio clinic or hospital

Achilles Tendon Repair Protocol


Phase I

Week 0 to 2


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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


  • 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 

Add a Comment

Your email address will not be published. Required fields are marked *