Achilles Operative Repair

0-2 Weeks

  • No weight-bearing
  • Splint in gravity equinus

2-4 Weeks

  • NO CALF STRETCHING
  • Weight-bearing as tolerated
  • Sutures out, incision check, new sterile strips
  • Wedge protocols
    • If 3 wedges initially placed: remove first wedge week 3.5, next wedge week 5, last wedge at 6 week visit
    • If 2 wedges initially placed: remove first wedge week 4, next wedge at 6 week visit

4-6 Weeks

  • NO CALF STRETCHING
  • Weight-bearing as tolerated
  • Remove sterile strips if they haven’t fallen off already
  • Wedge protocols
    • 3 wedges initially placed: remove first wedge week 3.5, next wedge week 5, last at week 6 visit
    • 2 wedges initially placed: remove first wedge week 4, next wedge at 6 week visit

6 Weeks

  • NO CALF STRETCHING (discuss with Dr. Hoopes if excessively tight)
  • Weight-bearing as tolerated.
  • Boot with no wedges after week 6 visit
  • Can begin gradual transition out of boot week 7 at soonest, but only if zero pain. If pain, delay/slow transition out of boot.
  • 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 lightweight resistance band
  • Start gentle seated belt stretch  (only if tight, usually not needed)
    • 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 good limb and shift one inch towards the injured limb each week. In a few weeks, weight will be centered over both limbs.

12 Weeks

  • Continue 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 AND near symmetric reps with single-limb here raise –> Plyometrics/Running