Download Achilles Repair Rehab Protocol

Weeks 1-2:

(Follow-up at 1 week and 2 weeks after surgery with Dr. Nwachukwu)

Goals

  • Protection of repair
  • Reduction of swelling to allow for soft tissue healing

Weight bearing

  • Non-weight bearing with crutches and/or scooter

Brace

  • Splint in plantarflexion
  • Follow-up 1 week after surgery and change to cast with ankle in plantarflexion for another week–this means 2 weeks total of no weight on your leg

Exercises

  • ELEVATE, ELEVATE, ELEVATE!

Weeks 2-4:

(Follow-up at 4 weeks after surgery with Dr. Nwachukwu)

Goals

  • Initiate formal physical therapy (2 times per week)
  • Begin graduated weight bearing
  • Active dorsiflexion up to neutral

Weight bearing

  • Initiate PWB in boot with 2 crutches then go down to 1 crutch and finally no crutches in the boot

Brace

  • Tall CAM boot with FOUR ½” heel wedges. Remove 1 wedge every 5-7 days as able. Should be no wedges by Week 6 follow-up

Treatment

  • Gentle scar massage and cryotherapy

Exercises

  • Active dorsiflexion to neutral only
  • No active plantar flexion
  • Pain-free ankle isometrics: inversion, eversion, dorsiflexion and sub-max plantar flexion
  • Open-chain hip and core strengthening in boot

Week 4– 6:

(Follow-up at 6 weeks after surgery with Dr. Nwachukwu)

Goals

  • Regain ankle ROM (active ROM between 50 DF and 400 PF)
  • May sleep out of boot if comfortable now

Weight bearing

  • Full

Brace

  • Boot at all times with 1-inch heel lift. Can remove for hygiene and exercises

Precautions

  • Avoid overstressing the repair (forceful movements in the sagittal plane, forceful plantar flexion while in a dorsiflexed position, aggressive PROM)

Treatment

  • Gentle cross fiber massage to achilles tendon to release adhesion between tendon and peritendon
  • Cryotherapy and other modalities add PRN

Exercises

  • Active ankle eversion/inversion
  • Passive dorsiflexion both with knee in extension and flexed to 35 – 400 until gentle stretch on achilles
  • Begin standing calf stretch at 5 weeks (knee flexed and extended)
  • Continue eversion, inversion and plantar flexion isometrics with resistance bands
  • Initiate balance exercises (double leg wide base ➔ narrow base)
  • Initiate stationary bike with minimal resistance
  • Initiate pool exercise in total buoyancy with floatation device if wound is fully healed
  • Hip and core strengthening

Weeks 7-12:

Goals

  • Normalize gait on level surface without boot or heel lift
  • Active ROM between 150 DF and 500 PF
  • Good control and no pain with functional movements

Brace

  • Supportive athletic shoes with ankle brace

Precautions

  • Avoid high impact activity

Exercises

  • Full PROM/AROM all planes. Avoid forceful dorsiflexion
  • Progress standing calf stretch
  • Initiate double leg toe raise and advance weight as tolerated
  • Initiate functional movement (squat, steps ups, lunges in all planes)
  • Advance balance training to wobble board and single leg activity
  • Initiate frontal and transverse plane agility drills (progress from low velocity to high and then gradually add in sagittal plane drills)
  • Progress cardiovascular training
    • Stationary bike, stairmaster, swimming, chest level water exercise, treadmill walking

3 – 6 Months:

Goals

  • Ankle strengthening
  • Regain normal gait
  • Initiate running

Precautions

  • Normal shoes.

Exercises

  • Progress double leg toe raises to body weight (1.5 times body weight athlete)
  • Advance to single leg toe raises as tolerated
  • Running progression at 5 months
    • Trampoline jogging ➔ treadmill ➔ outdoor running

6 – 9 Months:

Goals

  • Return to sport/job specific training

Precautions

  • Post-activity soreness should resolve after 24 hours
  • Avoid excessive activity related swelling and/or pain

Exercises

  • Progress running to sprinting
  • Initiate agility: figure of 8 and cutting drills 6 months
  • Jumping progression 6 – 7 months
  • Sport/job specific training
  • Full return to sport/strenuous work 8 – 9 months

Please note that these instructions are general guidelines to be followed; however, any written or verbal instructions provided by Dr. Nwachukwu supersede the instructions below and should be followed.