Achilles Tendon Repair — Early Weight-Bearing Achilles Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB in short leg cast or PF boot Phase I; protected WB in walker boot PF position with crutches (2-cm heel lift) Phase II, advancing to full WB in boot at wk 4; WBAT in walker boot Phase III; wean from boot after wk 8

Key Restrictions

Boot required while sleeping through Phase III; rest/elevation between ADLs Phase I; jogging/running and sport-specific retraining not until after 12 wks; return to sport MD-directed, generally >16 wks

Timeline & Phases

Phase I (surgery-2 wks): protect repaired tendon, reduce pain/swelling, NWB in short leg cast or PF boot (foot down OK when standing), rest/elevation between ADLs, hip/knee AROM, gait training with bilateral axillary crutches or Roll-About, progress to Phase II after 2 wks if incision healed; Phase II (2-6 wks): maintain hip/knee ROM, improve core/hip/knee strength, protected WB in walker boot PF position with crutches (2-cm heel lift), boot required while sleeping, advance to full WB in boot at 4 wks, toe flexion/extension, light foot massage for edema, core strengthening, hip/knee strength (clamshells, hip abduction, prone hip extension, SLR, TheraBand press), glute stretching, upper body circuit/ergometer, progress to Phase III after 6 wks; Phase III (6-8 wks): WBAT in walker boot allowed, boot required while sleeping, closed chain exercise progression, lunges/leg presses 0-90 deg, proprioceptive exercises, stationary bike, hip/core strengthening, scar mobilization (friction/ultrasound/stretching) as appropriate, begin weaning from boot after 8 wks; Phase IV (8+ wks): good eccentric/concentric neuromuscular control, multiplane limb control, wean from walker boot (consider crutches/cane as needed), closed chain exercise, proprioceptive exercises, stationary bike/StairMaster, hip/core strengthening, scar mobilization, jogging/running and sport-specific retraining after 12 wks, return to sport MD-directed generally >16 wks

Notes

OSMS Rehabilitation Guidelines; early-weight-bearing variant of OSMS's standard Achilles Tendon Repair protocol (compare: NWB-focused version at OSMSPT.AchillesRepair.pdf); full recovery can take up to a year with intermittent pains/aches common; references Baer & Keene and Willits et al. (2010) JBJS operative vs. nonoperative Achilles rupture study