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Achilles Tendon Rehab Protocol

Achilles tendon rupture image

Ankle Cross section image

Achilles tendon rupture image

Achilles tendon rupture approach

Achilles tendon incision image


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

  1. DeLee & Drez's, Orthopaedic Sports Medicine: 3e;  2009
  2. Calhoun JH, in Masters Technique Foot and Ankle, 2nd ed, 2002
  3. Saltzman CL, JAAOS, 1998;6:316
  4. Wilcox DK, Bohay DR, Anderson JG. Treatment of chronic Achilles tendon disorders with flexor hallucis longus tendon transfer/augmentation. Foot Ankle Int. 2000 Dec;21(12):1004-10.
  5. Den Hartog BD. Flexor hallucis longus transfer for chronic Achilles tendonosis. Foot Ankle Int. 2003 Mar;24(3):233-7
  6. Myerson MS. Achilles tendon ruptures. Instr Course Lect. 1999;48:219-30