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Typically patients are discharged on the day of the operation or the next day. The leg is usually immobilized in a cast or hinged brace, ranging from 4-8 weeks. During the period of immobilization, patients are encouraged to elevate the involved leg to avoid swelling. They are also told to perform isometric contractions of the calf muscles to prevent calf muscle atrophy. If put in a cast, patients are instructed in walking with crutches or taught how to walk with a hinged orthosis (rocker boot).

Week 1 - 4

  • Patient Education - use of rocker boot, appropriate weight bearing status
  • Gait, transfer, stair training (**PWB with rocker boot)
  • Gentle scar tissue mobs along Achilles tendon
  • Modalities (Hi-volt, interferential, cryocuff)
    • Moist heat after 2 weeks post-op
  • AROM - ankle dorsiflexion
  • PROM -ankle plantarflexion
  • Proximal kinetic chain strengthening program
    • SLRs (hip abd/add/flex/ext)
    • Stationary bike (with use of rocker boot)
    • Arch strengthening ex's (towel curls, etc)
    • Upper body conditioning program

Goals:

  • Protect the repair
  • Restore AROM
  • Minimize scar tissue formation
  • Decrease swelling

Week 4 - 6

  • Gait training (***WBAT/FWB with rocker boot at week 6)
  • Scar tissue mobs, modalities p.r.n.
  • Sub maximal isotonic ankle dorsi/plantarflexion and eversion
  • Seated BAPST board

Goals:

  • Continue to protect repair
  • Increase strength of repair
  • Full AROM

Week 6 - 8

  • Gait training (***FWB with rocker boot)
  • AAROM - dorsi/plantarflexion, inversion, eversion (Biodex or T-band)
  • Swimming (no finns)

Goals:

  • Improve fitness

Week 8 -12

  • Gait training (***FWB without assistive devices nor rocker boot)
  • Stationary bike (pushing through forefoot)
  • Stairmaster (pushing through forefoot)
  • BAPTS (standing)
  • Trampoline marching

At Week 10

  • Isokinetics- dorsi/plantar flexion
    • High speed concentric progressing from submax to max
  • Calf raises and eccentric calf lowering
    • Progress from supine position (on leg press with bilateral to unilateral support) to standing (bilateral to unilateral)
  • Retro-walking on decline
    • Eccentric closed chain exercises

Goals:

  • Restore normal gait
  • Full PROM
  • Continue to strengthen repair

Week 12 - 20

  • Jogging/retro jogging
  • Trampoline hopping
  • Forward, lateral stopovers (on box)
  • Sub maximal agility training (figure 8's, kareokees, shuffles)
  • Regular biking

Goals:

  • Return to normal function

Week 20 to 1 year

  • Plyometrics
  • Running, agility drills
  • Return to sports

Click here to download Printable Version of Achilles Tendon Repair Rehab Guidelines.