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.
NWB with crutches
Straight-Leg raises; open chain terminal knee extension; hamstring stretching; toe AROM
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
Walking boot with 1 cm heel lift
Same as Phase II
Same as Phase II
Walking boot with no heel lift
Slow DF stretching
Progress resistance exercises; propioceptive and gait training; WB cardio exercises (bike, elliptical, walking/running on treadmill)
Wean from boot and use crutches/cane as needed
Continue to progress strength and proprioception
*Boot is required while sleeping but can be removed for bathing and dressing.
**Use friction or ultrasound therapy for scar mobilization, not stretching.