Achilles Tendon Rehabilitation Protocol

Achilles Tendon Rehabilitation Protocol Frequency: 2 times weekly Duration: 12 weeks

Weeks 0-2:

• Non-weight-bearing in plantarflexion splint or KOBE boot set to level 3
• Will need crutches or alternative, such as a knee scooter

Weeks 2-4:

• Partial weight bearing in boot with 3 heel wedges or KOBE boot at level 2 with crutches.
• Physical Therapy / Home Therapy
  • Active dorsiflexion to neutral only. No passive dorsiflexion.
  • Modalities to control swelling
  • Hip/Knee exercises with no ankle involvement
  • Non-weight-bearing exercises (one leg bicycle, arm cycle, etc) o Pool Therapy (if available) within motion and weight bearing limitations

Weeks 4-6:

• Progress to weight bearing as tolerated in boot with 2 wedges (Remove bottom wedge) or KOBE boot set to level 1.
• At week 5, if using wedges, remove second wedge leaving only one remaining.
• Physical therapy / home therapy continues as above.

Weeks 6-8:

• Weight bearing as tolerated in boot with no lifts/wedges or KOBE boot set to level 0 with flat baseplate
• Physical Therapy
  • Active dorsiflexion stretching, slowly. Not beyond neutral. No passive stretching.
  • Graduated resistance exercises (open and closed kinetic chair, functional activities)
  • Proprioceptive and gait retraining
  • May begin biking, elliptical, walking on treadmill/stairmaster in boot.

Weeks 8-12:

• Wean from boot. May need crutches when out of boot. If so, wean gradually. Start with 1 to 2 hours out of boot per day. You may notice increased swelling.
• Shoes with single heel lift.
• Physical Therapy
  • Continue ROM, strength training, and proprioception.

Weeks 12-16:

• Continue with single heel lift in shoes until week 14.
• OK for barefoot at 16 weeks.
• Advance PT with strength power endurance, plyometric exercise, sport specific training.
  • No passive stretching beyond neutral dorsiflexion until after 16 weeks.
• From here on out, you can generally start pushing to return to full activities.
• Goal to return to full activities and sports by 6 months.