Post op Achilles tendon repair protocol
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Achilles tendon repair rehabilitation protocol postoperative guidelines early functional rehabilitation
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Achilles tendon repair rehabilitation
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site:massgeneral.org Achilles tendon repair rehabilitation protocol PDF weight bearing
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PMID: 37306060
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Postoperative Achilles tendon repair protocol
Use the specific protocol from your surgeon and physical therapist if it differs. Repair type, tissue quality, augmentation or tendon transfer, wound status, diabetes, smoking, and revision or chronic repair can require a slower program.
Core precautions
- Keep the ankle plantar-flexed initially. Do not force dorsiflexion past neutral in the early phase.
- Avoid active or resisted calf raises until cleared.
- Wear the boot as prescribed, including at night early on.
- Do not walk without the boot until you have been cleared.
- Progress only if pain, swelling, wound healing, and gait are satisfactory.
| Time after surgery | Protection and weight-bearing | Motion and rehabilitation |
|---|---|---|
| 0-2 weeks | Posterior splint in plantar-flexion; non-weight-bearing with crutches or scooter. | Elevation, swelling control, toe/knee/hip exercises. Keep incision clean and dry. No ankle motion unless surgeon directs otherwise. |
| 2-4 weeks | Transition to walking boot with about 2 cm heel lift. Protected partial weight-bearing with crutches, as tolerated and permitted. | Gentle active plantar-flexion and dorsiflexion only to neutral. Gentle inversion/eversion below neutral. Hip and knee strengthening; non-weight-bearing cardio such as single-leg cycling. Start scar care only after the incision is fully healed. |
| 4-6 weeks | Progress toward weight-bearing as tolerated in the boot, typically reducing crutch use when gait is controlled. | Continue protected ankle ROM. Gentle functional strengthening and gait training. No aggressive calf stretch. |
| 6-8 weeks | Continue boot and remove heel lifts gradually, according to the surgeon's schedule. | Gradually restore dorsiflexion, light resistance and closed-chain work, balance/proprioception, and gait retraining. |
| 8-12 weeks | Wean from boot into a supportive shoe, often with a temporary heel lift. Use cane/crutches temporarily if limping. | Advance ROM, calf strength, balance, stationary bike, elliptical, and controlled walking. Aim for a normal, non-antalgic gait before increasing loads. |
| 12-16 weeks | Regular shoe if gait and strength allow. | Progressive calf strengthening, single-leg balance, endurance, step-downs/squats. Introduce low-level hopping or plyometric drills only when cleared and strength/control are adequate. |
| 4-6 months | Return-to-running progression may begin if cleared. | Jogging, plyometrics, agility, and work or sport-specific training. |
| 6+ months | Return to pivoting or high-demand sport is individualized. | Common criteria include no pain/swelling, near-symmetric ankle ROM, good single-leg heel-rise endurance, and satisfactory functional testing. Some athletes need 9-12 months for full performance recovery. |
This schedule is consistent with the operative-repair rehabilitation table in Campbell's Operative Orthopaedics, which uses splint/non-weight-bearing for weeks 0-2; boot plus heel lift and protected weight-bearing for weeks 2-4; weight-bearing as tolerated by weeks 4-8; boot weaning at 8-12 weeks; then progressive strength, endurance, plyometrics, and sport-specific activity after 12 weeks. Campbell's Operative Orthopaedics, 15th ed., p. 2953.
AAOS guidance summarized in the same source supports protected weight-bearing within 2 weeks, with dorsiflexion limited, and a device allowing mobilization by 2-4 weeks after operative treatment. Campbell's Operative Orthopaedics, 15th ed., p. 2952.
Call your surgeon urgently for
- Increasing calf pain/swelling, chest pain, or shortness of breath
- Fever, worsening redness, drainage, wound separation, or foul odor
- Sudden pop, new loss of push-off strength, or abrupt swelling/bruising
- Numbness, blue/cold toes, or uncontrolled pain
Recent evidence supports early functional rehabilitation in appropriately selected patients, but its exact timing and safeguards vary by repair and surgeon. A 2024 systematic review also cautioned that apparent equivalence in rerupture outcomes between operative and early-functional nonoperative pathways may be statistically fragile (review abstract).
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