Achilles Tendon Rehab Protocol

Achilles Tendon Rehab Protocol

• The rehab protocol for repaired and nonsurgical repaired achilles tendon ruptures are very similar.
• The surgically repaired achilles will typically be removed from a cast and switched to a removable cast boot a little sooner than the nonsurgical achilles tendon rupture.

Phase I (Casted; NWB)

• The patient should be taught NWB crutch walking.
• The patient will be kept in a NWB cast 3 to 6 weeks depending on stability.
• Once sufficient stability is determined, the patient will be switched to a cast boot and then can proceed to phase II.

Phase II (Post casting; Removable Cast Boot; NWB)

• Patient is kept NWB for 3 more weeks in the removable cast boot.
• Active DF, eversion and inversion.
• Passive stretch PF.
• Edema control.

Phase III (Removable Cast Boot; WB)

• Three weeks after removable cast boot started.
• Begin progressively increasing weight bearing so that by the end of 6 weeks in the removable cast boot the patient is full weight bearing.
• Continue with active DF, eversion and inversion.
• Begin active PF.

Phase IV (Strengthening)

• After 6 weeks in the cast boot and patient is full WB, begin aggressive stretching exercises.
• Begin gastrocnemius/soleus, tibialis anterior, tibialis posterior, and peroneal strengthening. Begin with isometrics, then dynamic strengthening.
• Patient may begin jogging at 12 weeks from initiation of treatment.
• Teach sport specific strengthening if applicable.

Phase V (Return to pre-injury sports)

• After 4 months, patient may return to sports if ROM and strength are 85% of the normal side.

Achilles Tendon Review References