Achilles Nonoperative Protocol

0-2 Weeks

  • Boot or cast on 24/7 the first six weeks unless doing exercise
  • Equinus cast for two weeks
  • Non-weight-bearing

2-3 Weeks

  • Cam boot after two 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 you had three, if you had two, 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 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, you can begin light jogging

Running, higher energy activities

Ok to begin these gradually when you are able to perform single-limb heel rise that is as high as the uninjured side.