Achilles Tendon Repair

SOMOS (Society of Military Orthopaedic Surgeons) · Tri-Service Orthopedics & Physical Therapy Consultants

Weight-Bearing

Wks 1-2: TDWB (0-10% BW) in post-op splint with heel lift → WBAT; Wks 3-4: WBAT ¼" heel lift; Wks 5-6: WBAT heel lift PRN; CAM boot for all ambulation; D/C crutches when gait normalized (goal wks 4-6)

Key Restrictions

CAM boot for all ambulation; limit DF to 0° until 6 weeks; heel lift progression wks 1-6 (½" → ¼" → 1/8"); no submerging 4 weeks; no running until 4 months; discharge criteria: hop test + Y-balance >90%, isokinetic >85%, HHD >85% PF

Timeline & Phases

Phase 1 (wks 0-6): TDWB→WBAT in CAM boot, heel lift progression, DF limit 0° — ankle pumps, hip/knee AROM, quad/glute sets, intrinsic foot exercises, OKC hip/knee strengthening, ankle isometrics, calf pumps (neutral→PF), Achilles stretch pain-free (wks 3-4), ankle tubing all directions (wks 5-6), seated SL heel raises (wks 5-6); Phase 2 (wks 7-12): transition from boot to brace wks 7-8, no running until 4 months — bike, ankle ROM, seated wobble board, gait training (cones, marching, retro, cariocas), ankle strengthening, DL squats, step-ups 4" → progress, DL heel raises → DL→SL, gastroc/soleus stretching, progressive hip/knee strengthening, DL→SL balance, pool intermediate; Phase 3 (months 4-6): ankle lace-up brace PRN — stairmaster wks 13-16, progressive LE strengthening (calf press, leg press, squats, HS curls), light agility (fitter, slide board, figure 8s, agility ladder), jogging program wks 17-24 (10-20%/wk increase), progressive agility/functional training; Discharge: hop test + Y-balance >90%, isokinetic >85%, HHD >85% PF, iPRRS >50%; pass service fitness test 6-9 months; RTS aggressive military training 9-12 months

Notes

Tri-Service guidelines (Army/Navy/Air Force); published May 2020; military population; discharge criteria include isokinetic >85% and HHD >85% PF; RTS aggressive military training (e.g., airborne school) 9-12 months

Surgeon / Author

Tri-Service Orthopedics & Physical Therapy Consultants

Published

2020