Achilles Operative Repair

0-2 Weeks

  • No weight bearing
  • Splint in gravity equinus

2-4 Weeks

  • Weight bearing as tolerated. Crutches/walker if any pain.
  • Sutures out, incision check, new steri strips
  • Boot with 2 wedges night and day when not doing exercises/PT

4-6 Weeks

  • Weight bearing as tolerated.
  • Remove steri strips
  • Boot with 1 wedge night and day when not doing exercises/PT

6 Weeks

  • Weight bearing as tolerated.
  • Boot with 1 wedge until week 7
  • Boot with no wedges after week 7
  • Begin practicing single limb stance out of boot in controlled environment with therapist.
  • No night splinting needed
  • Work on active ROM ankle, subtalar joint.
  • Start light weight resistance band
  • Start gentle seated belt stretch 
    • Discontinue calf stretches if/when patient can dorsiflex to neutral.
  • Begin double limb heel raise with weight centered almost completely over the well limb. Gradually shift weight towards operative limb.
    • Good way to do this is to place fingertips on counter in front of patient and center the shoulders with the fingers. Begin with fingers centered in front of well limb and shift one inch towards the injured limb each week. In a few weeks, weight will be centered over both limbs.

12 Weeks

  • Out of boot to regular shoes
  • Start double-limb heel raise
  • Continue gradual shift of weight towards injured limb, as described above. As weeks progress, and per patient tolerance, begin to shift weight completely over the operative limb.

After 12 Weeks, Milestone-based

  • ONLY When able to perform single limb heel raise –> Start stair calf stretch (if still feels stiff)
  • When close to symmetric heel height with single-limb heel raise with uninjured side –> Plyometrics/Running