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.
