Achilles Tendon Rupture — Repair

Massachusetts General Hospital · MGH Sports Medicine

Weight-Bearing

NWB on crutches in splint wks 0-1; NWB in Achilles boot with 3 wedges wks 2-3; WBAT in boot with 3 wedges and crutches from wk 4 (shoe leveler on uninvolved side); remove 1 wedge at wk 6, wk 8 and wk 10; boot with no wedges and no assistive device from wk 10; sneaker with 1 cm heel lift at wks 12-14 (boot for unpredictable outdoor surfaces)

Key Restrictions

Avoid over-elongation of Achilles; conservative approach for augmentation, re-rupture, revision, chronic tendinosis, obesity, older age, steroid use; no overt or prolonged Achilles stretching; do not force DF; eccentric loading into DF (incline or off-step heel raises) not until Phase VII (6+ months)

Timeline & Phases

7 phases: Phase I (0-1 wks, NWB in splint, proximal strengthening), Phase II (2-3 wks, NWB in boot with 3 wedges, ankle AROM/AAROM without DF past limit), Phase III (4-5 wks, WBAT in boot with wedges), Phase IV (6-11 wks, wedge removal, bike in boot), Phase V (12-14 wks, sneaker with 1 cm heel lift, standing calf raise progression), Phase VI (3.5-6 months, plyometrics, Alter-G walk/jog), Phase VII (6+ months, return to running, agility and plyometric programs, return to sport with MD clearance); includes return-to-run and agility/plyo programs

Notes

Criterion-based; DF to neutral by wk 6; heel raise endurance test; progression to Phase VII requires heel rise endurance >90% of uninvolved side and 30 min of fast walking without pain or swelling; revised 3/2026; references included.

Surgeon / Author

MGH Sports Medicine