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.
