Precautions
- Protect the Achilles insertion: no aggressive calf stretching until cleared (unless specified). Dorsiflexion strengthening only to the first point of resistance early.
- Weight bearing depends on the procedure: after isolated Haglund's resection, protected weight bearing progresses over the first ~4 weeks; if the Achilles was debrided or reattached, remain non-weight-bearing longer (~4 weeks) per surgeon.
- Control edema with elevation and light massage.
Phase I · Weeks 1–3 (Protect)
- Non-weight-bearing ~2 weeks (knee scooter or crutches); the foot may rest down when standing or sitting.
- Begin gentle ankle active ROM (seated) as tolerated — no passive stretching.
- Hip and knee active ROM (lying and standing).
- Sutures removed at 14–21 days.
Phase II · Weeks 3–6 (Progressive Weight Bearing)
- Progressive weight bearing in a walker boot (~25% per week). Start with 3 heel wedges; remove one wedge per week beginning week 3.
- Transition to a regular shoe by ~6 weeks (as tolerated). Shower once sutures are out and the wound is healed.
- Ankle AROM; gentle resistance-band strengthening with dorsiflexion limited to the first point of resistance. No calf stretching.
- Light edema massage (toes toward ankle); elevation.
Phase III · Weeks 7–10 (Restore Motion)
- Manual and subtalar joint mobilization as needed.
- Ankle ROM: plantarflexion, inversion/eversion, and dorsiflexion to the first point of resistance. No calf stretching — ask the surgeon if ROM seems insufficient.
- Control knee hyperextension (a common compensation for limited ankle dorsiflexion).
Phase IV · Weeks 10–12 (Build Strength)
- Goal: increase dorsiflexion and strength.
- Stationary bike (add tension); seated active plantarflexion, dorsiflexion to tolerance.
- Regular shoes as tolerated.
Phase V · Weeks 13–16 (Function & Balance)
- Theraband inversion/eversion and dorsiflexion; gentle calf stretches may now begin; calf press and leg press.
- Proprioception and single-leg support → wobble board; gait retraining; swimming and stepper; eccentric heel drops.
- Progress to dynamic drills, hopping and skipping → sport-specific drills at 16+ weeks.
Phase VI · Weeks 16+ (Return to Activity)
- Full lower-extremity strength and maximal function; work/sport-specific activity; arch control.
- Strength through running, band work, and heel raises — progress double-leg to single-leg heel raises.
Return to Sport (~6 Months / Week 26)
- Return to competitive sport when a single-leg heel raise and single-leg hop are intact and symmetric.
References
- Insertional Achilles Tendinopathy with Haglund's Deformity: A Progressive Approach to Post-Operative Rehabilitation in Athletes. Int J Sports Phys Ther, 2024–2025.
- Weight-bearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Large Retrospective Analysis. PMC, 2024.
Modernized to current practice: clarified that weight-bearing progression depends on whether the Achilles was debrided/reattached, corrected text artifacts from the prior file, permitted gentle calf stretching only from Phase V, and framed return to sport around single heel-rise/hop criteria.