Achilles Tendon Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB in short leg cast or plantarflexed boot Phase I; partial WB in walker boot in PF position Phase II (remove 1 wedge every 3 wks); WBAT without brace allowed Phase III

Key Restrictions

Rest and elevation between ADLs Phase I; heat before exercise, ice after in Phase III; single leg strengthening, jogging/running, and sport-specific exercises 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, partial WB in walker boot in PF position (remove 1 wedge every 3 wks), control swelling with elevation, toe flexion/extension, light foot massage for edema, core strengthening (abdominal recruitment, bridging, ball reach, resisted diagonal TheraBand), hip/knee strength (clamshells, hip abduction, prone hip extension, SLR, TheraBand press), leg press machine ok at 3 wks, glute stretching, upper body circuit/ergometer, progress to Phase III after 6 wks; Phase III (6+ wks): good eccentric/concentric neuromuscular control, multiplane limb control, heat before/ice after exercise, WBAT without brace allowed, closed chain exercise progression, lunges and leg presses 0-90 deg, proprioceptive exercises, stationary bike, hip/core strengthening, single leg strengthening and jogging/running after 12 wks, sport-specific exercises, return to sport MD-directed generally >16 wks

Notes

OSMS Rehabilitation Guidelines; full recovery can take up to a year with intermittent pains/aches common during that time; references Baer & Keene (Orthopedic Sports Medicine: Principles and Practice) and Van der Linden et al. (2003) on fluoroquinolone-associated Achilles rupture risk