Achilles Tendon Tear Rehab Protocol

Keys to Success

Patients who are treated nonsurgically 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 6 months after injury. High-impact activities (eg, soccer, football, rugby) may be considered after 9 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	Straight-Leg raises; open chain terminal knee extension; hamstring stretching; toe AROM
Weeks 2-4*	Walking boot with 2 cm heel lift	Active PF and DF to neutral; Inversion/Eversion below neutral	Protected WB with crutches	Incision mobilization; hip/knee exercises with no ankle involvement; NWB cardio exercises
Weeks 4-6*	Walking boot with 1 cm heel lift	Same as Phase II	WBAT	Same as Phase II
Weeks 6-8	Walking boot with no heel lift	Slow DF stretching	WBAT	Progress resistance exercises; propioceptive and gait training; WB cardio exercises (bike, elliptical, walking/running on treadmill)
Weeks 8-12	Wean from boot and use crutches/cane as needed	Progress A/PROM	WBAT	Continue to progress strength and proprioception
Weeks 12+	None	FAROM	WBAT

*Boot is required while sleeping but can be removed for bathing and dressing.

**Use friction or ultrasound therapy for scar mobilization, not stretching.