Haglund's Deformity PT Protocol

Therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 9 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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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.

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.