Achilles Non-Operative Protocol

0-2 Weeks

  • Boot or cast on 24/7 first 6 weeks unless doing exercises
  • Equinus cast for 2 weeks
  • Non weight-bearing

2-3 Weeks

  • Cam boot after 2 weeks (with two or three  7/16th heel wedges, depending on comfort)
  • 25% weight bearing
  • Active DF to tolerance (not past neutral)

3-4 Weeks

  • Cam boot, go to two heel wedges if had three. If had two wedges, stay at two.
  • 50% weight bearing
  • Active DF to tolerance (not past neutral)

4-5 Weeks

  • Cam boot, go to one heel wedge only.
  • 75% weight bearing
  • Active DF to tolerance (not past neutral)

5-6 Weeks

  • Cam boot, stay at one heel wedge.
  • 75% weight bearing
  • Active DF to tolerance (not past neutral)

6-8 Weeks

  • Cam boot, zero heel wedges
  • 100% weight bearing
  • Begin to practice SLS balancing when full WB

After Week 8

  • Regular Shoes
  • Full weight bearing, no crutches
  • Continue to practice SLS balancing
  • Begin progressive resistance with light resistance band
  • Start DLS heel raise, gradually shift toward SLS as tolerated
  • Light tension belt stretch when in shoe-Stair calf stretch when able to perform SLS heel raise
  • When able to walk without any pain at all in regular shoes, can begin light jogging

Running, Higher Energy Activities

  • Ok to begin these gradually when able to perform single limb heel rise that is as high as the uninjured side