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Achilles Tendon Repair - Physical Therapy Protocol

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Preoperative Guidelines

  • Restore full AROM
  • Teach normal heel-toe gait
  • Strengthen involved extremity
  • Decrease edema if present
  • Educate patient on post-op protocol, use of crutches (level surfaces and stairs)

Note: Exercise prescription is dependent upon the tissue healing process and individual functional readiness in all stages. If any concerns or complications arise regarding the progress of any patient, physical therapy will contact the orthopedist.

Phase I (Post-op Day 1 –2 weeks) Watch for skin breakdown

  • Posterior Splint (remove for ROM/hygiene)
  • Crutches – NWB
  • SLR x 4
  • Gentle PROM 10° DF to 20° PF
  • Contralateral toe raises
  • Ice and elevation

Goals – pain and edema control, protection

Phase II (Weeks 3-4)

  • Hinged walking boot blocked at 10° less than neutral DF and unlimited PF
  • Crutches – Progress weight bearing as tolerated
  • Stationary bike warm-up (boot on)
  • AROM as tolerated
  • Isometrics x 4, progress to theraband as tolerated
  • Well-Leg theraband if tolerated (if not tolerated, then SLR x4 with weight mid calf)
  • Pool (when incision healed): walking all directions, ROM, double calf raises in pool

Goals – Minimize quad atrophy and protect repair, full PF ROM

Phase III (Weeks 5-6)

  • WBAT with cane in cam walker blocked at neutral, or cowboy boot
  • Continue appropriate previous exercises...progress AROM and strength as tolerated
  • Towel crunches, marble pick-ups, towel scoots
  • Gentle scar mobilization when wound well healed – keep moist with vitamin E
  • Stretch HS
  • Single leg balance on level surfaces

Goals – No adhesions, DF to 0°

Phase IV (Weeks 7-12)

  • D/C hinged boot/cowboy boot-emphasize normal gait. May need heel lift or heeled shoe
  • Continue scar mobilization to ensure no adhesions
  • Con’t stationary bicycle
  • Stairmaster, Elliptical, treadmill walking progression
  • Wall sits, mini squats
  • Double leg heel raise
  • Proprioceptive exercises – BAPS, ball toss, body blade
  • Pain free achilles tendon stretching in non weight bearing (strap or towel)
  • Pool running

Goal – DF to 10°, normal gait, walk 2 miles at 20 min/mile pace or better

Phase V (Months 3 – 4)

  • Functional activities – Fitter, slide board, figure 8’s, gentle loops, large zigzags
  • Single leg heel raises…emphasize eccentric lowering (slowly)
  • Continue strengthening, bicycle, Stairmaster, Elliptical, proprioceptive exs
  • Treadmill – Walk-Jog progression program when gait is normal

Goals - No calf atrophy, Run 2 miles at comfortable pace

Phase VI (Months 4+)

  • Full activity/agility drills/plyometrics/progress to sports participation

Goals – Return to all activities

No contact sports until 6 months post-op


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