Achilles Tendon Repair

University of Virginia Orthopaedic Surgery

Weight-Bearing

NWB weeks 0-2; PWB with crutches progressing to FWB by weeks 3-4; FWB in boot weeks 4-8; boot discontinued after 8+ weeks (once walking without heel lift for 1 week)

Key Restrictions

Equinus cast 15-20° plantarflexion weeks 0-2 (posterior plaster splint if swelling severe); boot with 1" heel lift (4 x 1/4" lifts) weeks 2-4; remove one 1/4" lift per week with goal of no lift at 8 weeks; DF stretching and resisted plantarflexion not until week 6; boot discontinued only after walking 1 full week without heel lift

Timeline & Phases

Wks 0-2: equinus cast 15-20° PF (posterior plaster splint if severe swelling), NWB; Wks 2-4: boot with 1" heel lift (4 x 1/4" lifts), PWB with crutches progressing to FWB by wks 3-4, AROM plantarflexion (unrestricted) and dorsiflexion to neutral in boot; Wks 4-8: FWB in boot, remove 1/4" heel lift each week (goal: no lift at wk 8), DF stretching from wk 6, resisted plantarflexion from wk 6; Wks 8-12: discontinue boot after 1 week of walking without lift, progressive PT-guided strengthening/ROM/proprioception

Notes

Graduated heel lift removal (1/4" per week) is key: 1" total at week 2, none by week 8; active plantarflexion unrestricted in boot from week 2; DF to neutral permitted from week 2 but DF stretching and resisted PF not until week 6; boot discontinued once patient walks without any heel lift for 1 week; strengthening and proprioception training begin weeks 8-12 under PT guidance

Published

01/2023