ACHILLES TENDON REPAIR PROTOCOL

ACHILLES TENDON REPAIR PROTOCOL

This protocol provides appropriate guidelines for the rehabilitation of patients with Achilles tendon repair. The protocol draws evidence from the current literature and accounts for preferences of the providers at Sports & Orthopaedic Specialists. The program may be modified by the referring provider for an individual patient. If questions arise regarding the utilization of the protocol or the progress of the patient, contact Sports & Orthopaedic Specialists:

Phase I (Weeks 0-3): 

Goals: Wound healing and edema control.

Weeks 0 – 1

1. Postoperative dressing care.
2.  Elevation ankle/foot.
3.  Crutches, no weight-bearing.

Weeks 1 – 2

1. Postoperative dressing replaced with rigid orthosis walking boot. (CAM walker or AIRCAST-type boot)
2.  Postoperative walking boot with heel wedges (3 Wedges, 9/16 inch each).
3. Crutches, no weight-bearing.
4. Elevation.
5. Icing with Cryo-cuff (Out of splint 3 x daily).

Weeks 2 – 3

1. Continue with Week 2 protocol
2. Begin AROM (PF, INV, EV, & Dorsiflexion to Neutral 90 degree’s only).

 Phase II (Weeks 3-6): 

Goals: Progress to full weight-bearing, AROM to at least neutral, early strengthening (T-band “Progressive” PF, INV, EV, & Dorsiflexion to neutral only.

Weeks 3 -4

1. One heel wedge removed from walking boot.
2. AROM (PF, INV, EV, & Dorsiflexion to neutral only).
3. Stationary Bike with walking boot.
4. Icing.

Weeks 4 – 6

1. Progress to full weight-bearing with walking boot.
2. Remove remaining heel wedges in walking boot to neutral.
3. AROM (PF, INV, EV, & Dorsiflexion to neutral only).
4. Stationary Bike.
5.   Icing.

Week 6

1. Discontinue walking boot.
2. One quarter inch to 3/8-inch heel lift in shoe.
3. Stationary bike.
4. Stair climbing machine – light workout (Maintain Dorsiflexion at neutral).
5. Seated toe raises – Wall/Chair.

Phase III (Weeks 7-8):

Goals: Normalize gait

1. Full ROM.
2. Unilateral toe raises, Eccentric bilateral heel raises – Foot flat.
3. Heel lift in tennis/dress shoes.
4. Leg press for quadriceps strengthening.
5. Icing.

Phase IV (Weeks 8-12):

1. Discontinue heel lift.
2. Strengthening exercises: bilateral concentric heel raises, unilateral concentric toe raises.

Phase V (3-6 months): 

1. Walk or jog progression.
2. Sport-specific agility skills.
3. Continue with strengthening exercises.
4. Swede-O brace application.
5. Functional progression – full return to activities.

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