Achilles Tendon Repair

University Hospitals · Chris LeVan, PT; Daniel Chelette, PT; Lauren Bertagnolli, PT (reviewed by Mario…

Weight-Bearing

NWB w/ crutches 0-2 wks; PWB in boot w/ heel lifts wks 2-4; WBAT in boot by 4 wks; boot D/C ~4-6 wks when pain-free gait; transition to shoe 8-10 wks

Key Restrictions

No active or passive dorsiflexion past neutral for 8 wks (greatest tendon elongation risk 2-6 wks post-op); avoid passive gastroc stretching until 12-16 wks; avoid running/jumping until criteria met (~12-16 wks); return to sport testing at 24 wks

Timeline & Phases

Phase I Protection (0d-2wks): NWB, posterior splint/CAM boot at ~20deg PF, no DF ROM; Phase II Early Loading (2-6wks): WB in boot w/ wedges progressing to FWB by 4-6wks, no DF past neutral; Phase III Progressive Loading (6-12wks): wean boot/heel lifts to shoe, AROM progression, avoid gastroc stretch; Phase IV Advanced Loading (12-24wks): plyometric/running progression once 80% LSI PF strength and symmetrical ROM met; Phase V Return to Sport (6+ months): RTS testing and physician clearance, agility/sport-specific training

Notes

Covers both open and percutaneous repair techniques; expected recovery 6-9 months, return to sport 9-12 months; uses NMES and blood flow restriction (BFR) training 2-4 wks, aquatic therapy if available; outcome measures: FAAM, PSFS; RTS criteria include 90% LSI single heel raise/hop testing, Y-balance, <11s T-agility test; includes phased running progression and return-to-sport testing appendices with references

Surgeon / Author

Chris LeVan, PT; Daniel Chelette, PT; Lauren Bertagnolli, PT (reviewed by Mario Gastaldo, PT, Diana Gabriel, PT; physician review: Shana Miskovsky, MD)

Published

2025-01