Principles
- Functional (early-motion) rehab — criterion-based, guided by comfort, swelling, and calf strength; use pain as your guide.
- Protect tendon length: no dorsiflexion past neutral until ~week 8–10.
Phase 1 · Weeks 0–2 (Protect & Load)
- CAM walker boot with 2 heel lifts (equinus).
- Weight bearing as tolerated in the boot, using crutches for balance as needed.
- Elevation and edema control; a compression stocking under the boot can help with swelling.
Phase 2 · Weeks 2–4
- Continue the boot with 2 heel lifts; advance to full weight bearing in the boot as tolerated.
- Begin active plantarflexion and dorsiflexion to neutral only.
- Knee/hip exercises with no ankle involvement (seated, prone, or side-lying leg lifts).
Phase 3 · Weeks 4–8
- Full weight bearing in the boot; reduce to 1 heel lift.
- Begin physical therapy and a low-resistance stationary bike; progress to resisted calf strengthening (Theraband/weights) by ~week 6.
- Continue to avoid dorsiflexion past neutral.
Phase 4 · Weeks 8–12 (Wean to Shoe)
- Wean out of the boot into a shoe with a heel lift (crutches initially if needed).
- Progressive range of motion, now gently past neutral as tolerated.
- Add elliptical and treadmill walking; wobble board (seated → supported standing); standing calf stretches.
- Double-leg → single-leg heel raises — do not drop the heel below neutral early.
Phase 5 · Months 3–5 (Strength & Function)
- Progress calf strengthening (including eccentric), balance, and proprioception.
- Begin dynamic weight-bearing and sport-specific training as heel-rise strength improves.
Return to Sport (Criterion-Based, ~4–6 Months)
- Single-leg heel-rise height and endurance ≥90% of the other leg
- No pain or swelling; normal gait and running mechanics
- Tolerates sport-specific demands
- Physician clearance
References
- AOFAS Position Statement: Management of Acute Achilles Tendon Ruptures. 2024.
- Rehabilitation regimen for non-surgical treatment of Achilles tendon rupture: systematic review and meta-analysis of RCTs. 2021.