Phase I — Surgery to 2 Weeks
Appointments
- First post-operative visit at 10–14 days for wound check and suture removal.
Rehabilitation Goals
- Protect the repair.
- Control swelling and promote wound healing.
- Begin immediate protected weight bearing.
Precautions & Weight Bearing
- CAM walking boot with a 2 cm heel lift (or 2–3 heel wedges).
- Weight bearing as tolerated in the boot, using crutches as needed.
- Sleep in the boot. Keep the incision dry. Elevate to control swelling.
Suggested Therapeutic Exercise
- Out of the boot (seated), gentle pain-free active plantarflexion and dorsiflexion to neutral.
- Toe, knee, and hip range of motion.
Cardiovascular Exercise
- Upper Body Ergometer (UBE) / non-weight-bearing cardio.
Progression Criteria
- Comfortable weight bearing as tolerated in the boot; wound healing on track.
Phase II — 2 to 6 Weeks
Appointments
- Physical therapy 1–2 times per week.
Rehabilitation Goals
- Advance to full weight bearing in the boot.
- Active ankle range of motion (plantarflexion and dorsiflexion to neutral).
- Normalize gait in the boot.
Precautions & Weight Bearing
- Continue CAM boot with heel lift; advance to full weight bearing in the boot.
- Active plantar/dorsiflexion to neutral; inversion/eversion below neutral.
- No passive dorsiflexion stretching past neutral. Sleep in the boot.
Suggested Therapeutic Exercise
- Active ankle ROM within limits.
- Pain-free isometrics (plantarflexion, dorsiflexion, inversion, sub-max eversion).
- Open-chain hip and core strengthening; modalities for swelling; hydrotherapy within limits.
Cardiovascular Exercise
- Upper-extremity circuit training or UBE.
Progression Criteria
- Full weight bearing in the boot.
- Pain-free active dorsiflexion to neutral.
- No wound complications by ~6 weeks.
Phase III — 6 to 12 Weeks
Appointments
- Physical therapy weekly.
Rehabilitation Goals
- Wean out of the boot into a regular shoe.
- Normalize gait without the boot.
- Restore full active range of motion.
Precautions & Weight Bearing
- Weeks 6–8: discontinue the heel lift; begin gentle dorsiflexion stretching.
- Weeks 8–12: gradually wean out of the boot (crutches or a cane as needed, then wean off).
Suggested Therapeutic Exercise
- Graduated resistance exercise (open- and closed-chain, functional).
- Heel-raise progression: bilateral, advancing toward single-leg.
- Proprioception/balance and gait retraining; stationary bike; pool exercise if the wound is healed.
Cardiovascular Exercise
- Weight-bearing-as-tolerated cardio; hydrotherapy.
Progression Criteria
- Normal gait without the boot.
- Full active ROM.
- Single-leg stance control; able to perform a bilateral heel raise.
Phase IV — 12 Weeks to ~4 Months
Appointments
- Physical therapy every 1–2 weeks.
Rehabilitation Goals
- Single-leg heel-rise strength.
- Begin a running progression.
Precautions & Weight Bearing
- Progress impact gradually.
- Post-activity soreness should resolve within 24 hours; avoid running with a limp.
Suggested Therapeutic Exercise
- Concentric and eccentric gastroc/soleus strengthening; single-leg heel raises.
- Plyometric progression (low to higher velocity); agility drills; dynamic balance.
Cardiovascular Exercise
- Stationary bike, stair master, swimming; begin run-walk progression when criteria are met.
Progression Criteria
- Adequate single-leg heel-rise endurance (approaching the non-surgical side).
- Pain-free running mechanics without a limp.
Phase V — ~4 to 6 Months (Return to Sport)
Appointments
- Physical therapy every 1–2 weeks as needed.
Rehabilitation Goals
- Good control and no pain with sport/work-specific movements, including impact.
Precautions & Weight Bearing
- Post-activity soreness should resolve within 24 hours.
- Avoid post-activity swelling; avoid compensatory limp.
Suggested Therapeutic Exercise
- Sport/work-specific power, agility, and plyometric drills.
- Replicate sport/work-specific energy demands.
Progression Criteria
- Return to sport is allowed based on strength testing (limb symmetry), jump-and-landing mechanics, balance testing, and clinical clearance — typically 4–6 months.
Accelerated, early-functional protocol adapted from published evidence-based Achilles rehabilitation guidelines. Progression is criteria-based; individualize to repair quality and patient factors.