Achilles Tendon Rupture — Non-Operative

Saint Louis University (SLUCare) · Dept. of Orthopaedic Surgery

Weight-Bearing

NWB on crutches wks 0-2; WBAT with crutches in boot wks 2-4; progress to FWB (crutches for balance if needed) wks 4-8; normal walking and boot weaned by 12 wks; normal shoes from 12 wks

Key Restrictions

Plaster cast or rigid boot with foot in 20 deg plantarflexion and 3 wedges (22/16/10 mm), boot 24 hrs/day wks 0-4; remove one wedge per week from wk 4 until foot flat (plantigrade by 6-8 wks); dorsiflex only to the position allowed by the boot or wedges, never beyond, until 12 wks; no knee hyperextension to compensate for limited DF; jogging, plyometrics and cutting drills not until Phase V (12-24 wks); explosive actions and return to sport at 24+ wks

Timeline & Phases

6 phases: Phase I Rest (0-2 wks, NWB, immobilized, elevate, maintain hip/knee/toe movement), Phase II Easy Walking (2-4 wks, WBAT in boot, gentle supervised active PF from boot position), Phase III Walking (4-8 wks, wedges removed weekly, theraband PF/inversion/eversion, seated heel raises, bike in boot), Phase IV Easy Active (8-12 wks, wean boot by 12 wks, proprioception in and out of boot), Phase V Active (12-24 wks, normal footwear, single heel raises, jogging, plyometric squats/lunges, hopping, cutting drills, sport-specific rehab), Phase VI Full (24+ wks, normal activity, explosive actions, return to sport)

Notes

.edu site; non-operative (functional) Achilles protocol using a wedged boot; wedges removed one per week to plantigrade; DF limited by boot position until 12 wks; return to sport at 24+ wks

Surgeon / Author

Dept. of Orthopaedic Surgery