Achilles Tendon Debridement Rehab Protocol

Keys to Success

Patients who are treated non-surgically must take added caution because suture fixation makes surgical repair more robust than nonsurgical treatment.
It is important to avoid dorsiflexion the Achilles tendon beyond neutral in the first 6 weeks of treatment, after which the patient may begin controlled progressive stretching.
The healing tendon is vulnerable, and care must be taken to avoid sudden loading of the Achilles tendon during activities of daily living (eg, ascending stairs) because it can result in rerupture.
Gradual return to low-impact activities may commence at 2 months after injury. High-impact activities (eg, soccer, football, rugby) may be considered after 4-6 months if the ability to perform a single-limb heel rise is demonstrated.

Phase	Splint/Boot	ROM	WB	Exercises
Weeks 0-2	Splint	None	NWB with crutches/ walker	Straight leg raises, open chain terminal knee extension, hamstring stretching, toe AROM
Weeks 3-4	Walking boot	Gentle AROM/PROM	PWB with crutches/ walker	Scar mobilization if incision fully healed; AROM may begin @ 3 weeks; STM of calf; continue Phase I exercises
Weeks 5-6	Walking boot	Progress AROM/PROM	WBAT with crutches	Add towel stretches for calf; sitting BAPS board Levels 1-3; gentle theraband strengthening (DF, IN, EV)
Weeks 7-8	Wean from boot	Progressive FAROM	WBAT; wean from crutches	Gentle standing gastroc/soleus stretching; general lower extremity strengthening
Months 2-3	None	FAROM	WBAT	SLS exercises; progress lower body strengthening exercises; gentle stair stretching
Month 4-6	none	FAROM	WBAT	Begin agility and sport-like exercises