Achilles Tendon NON-Operative Protocol

Functional rehabilitation — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 8 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

After hours & emergency numbers → Weekdays, business hours.

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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.
Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.