Achilles Tendon Tear Rehab Protocol

Keys to Success

Patients who are treated nonsurgically must take added caution because suture fixation makes surgical repair more robust than nonsurgical treatment.
It is important to avoid dorsiflexion the Achilles tendon beyond neutral in the first 6 weeks of treatment, after which the patient may begin controlled progressive stretching.
The healing tendon is vulnerable, and care must be taken to avoid sudden loading of the Achilles tendon during activities of daily living (eg, ascending stairs) because it can result in rerupture.
Gradual return to low-impact activities may commence at 6 months after injury. High-impact activities (eg, soccer, football, rugby) may be considered after 9 months if the ability to perform a single-limb heel rise is demonstrated.

Phase	Splint/Boot	ROM	WB	Exercises
Weeks 0-4	Splint then walking boot with 4 heel wedges	None	NWB with crutches	Quad sets, SL raises; knee extension; hip abduction and clamshell, passive hamstring stretching; toe AROM
Week 4	Walking boot with 3 heel wedges	Active PF and DF to neutral; Inversion/Eversion below neutral	Protected 25-50% WB with crutches	Incision mobilization; cardio exercises, ankle pumps, circles, heel slides; no DF beyond 0°
Week 5	Walking boot with 2 heel wedges	No DF past 0°	Progress to WBAT	Progress
Week 6	Walking boot with 1 heel wedges	No DF past 0°	WBAT	Planks (in boot), seated heel raises, arch doming
Weeks 7-8	Walking boot without wedge	Progress SLOWLY to FAROM	WBAT	Stationary bike (in boot), 4-way ankle resistance band; hip strengthening
Weeks 9-10	Regular shoe with 1 cm heel lift	FAROM	WBAT	Ankle/foot mobilizations, ankle DF stretch on step, flutter kick swimming/pool jogging, calf raise progressions.
Weeks 11-12	Wean heel lift from shoe	FAROM	WBAT	Progress with ROM, cardio, strengthening, balance, proprioception
Months 3-6	Regular shoes	FAROM	WBAT	Elliptical, stair climber, progress with standing heel raises, lunges, squats, plyo
Months 6+	Regular shoes	FAROM	WBAT	Initiate gentle standing gastroc/soleus stretch, walk/jog program, plyo, agility

*Boot is required while sleeping but can be removed for bathing and dressing.

**Use friction or ultrasound therapy for scar mobilization, not stretching.