Achilles Tendon Repair Rehab Protocol

By Dr. Shayne Kelly, DO — Fellowship-Trained Sports Medicine Surgeon · Tri-City Orthopedics, Kennewick, WA

The written protocol Dr. Kelly provides to his patients and their physical therapists in the Tri-Cities. Time frames are guidelines — progression is criteria-based, and your own post-op instructions always govern.

⬇ Printable protocol (PDF)Request an appointment →

Educational information, not medical advice. This is not a substitute for the specific instructions Dr. Kelly and your physical therapist give you. Your timeline depends on your surgery, your body, and your progress. Follow your own care team's directions. In an emergency, call 911.

0–4 Weeks

PROTECT THE REPAIR

4–6 Weeks

PROTECTED WEIGHT BEARING

6–8 Weeks

PROGRESS WEIGHT BEARING

8–10 Weeks

FULL WEIGHT BEARING

10–12 Weeks

STRENGTHEN

•Posterior Splint (short leg, neutral ankle); NWB with crutches

0–4 WeeksPROTECT THE REPAIR

•Patient will begin therapy at approximately 2 weeks post-op.
•They will be NWB for 4 weeks. Usually patient will have been casted / splinted for about 2 weeks and then fitted in a walking boot with a wedge.

GOALS Strict NWB

4–6 WeeksPROTECTED WEIGHT BEARING

•PWB in walking boot, two crutches, beginning at week 4 (if no Achilles pain).
•Walking boot set at 15° PF, no movement allowed.
•PT is for ROM and gentle stretching at this stage (also for scar tissue massage if/when wound has healed, steri-strips off).
•Modalities: cryotherapy and e-stim for edema control
•Exercises to be performed at this stage are as follows and should be performed as long as no increased discomfort is experienced in the Achilles region.
•Ankle AROM in all planes (DF, PF, INV, EV, CW, CCW, ankle alphabet); NWB gastroc and soleus towel stretches
•Intrinsic foot exercises (marble pick-up and towel scrunches); seated BAPS; stationary bike (low resistance)
•NWB LE exercises such as SLR, SAQ, LAQ, and hamstring curls.

GOALS PWB in boot

6–8 WeeksPROGRESS WEIGHT BEARING

•Walking boot to allow 0–20° motion during ambulation, PWB; progress PWB and wean from crutches as tolerated.
•Continue PROM and joint mobilizations as needed; continue scar tissue massage.
•Continue cryotherapy and e-stim for edema control as needed
•Exercises to be performed at this stage are as follows and should be performed as long as no increased discomfort is experienced in the Achilles region.
•Theraband exercises (DF, PF, INV, EV); gait training out of boot
•Begin with unilateral on treadmill emphasizing heel to toe contact
•Progress to bilateral treadmill and /or level ground ambulation
•Leg press/shuttle exercise with light resistance if ROM allows
•Unilateral balance on stable surface (only at week 8 if patient is ready)

GOALS Wean crutches

8–10 WeeksFULL WEIGHT BEARING

•FWB without assistive device,
•Progress walking boot ROM slowly from 0–20° to full as tolerated by patient; PROM and joint mobilizations as needed.
•Begin weight bearing and balance exercises as tolerated.
•Unilateral balance on stable surface (progress to unstable as tolerated)

EXERCISES

•Standing gastroc and soleus stretches; FWB exercises such as partial squatting and partial lunging
•Contrakicks and advanced dynamic balance exercises; bilateral calf raises (start supine on shuttle or leg press machine)
•Standing BAPS; continue gait training to eliminate antalgic pattern

GOALS FWB, no device

10–12 WeeksSTRENGTHEN

•At week 10 discontinue walking boot.
•Continue manual techniques as needed (PROM, scar tissue massage, manual stretching)

EXERCISES

•Moderate paced walking on treadmill; stairmaster; progress squatting and lunging depth
•Unilateral balance (stable, then unstable) with ball toss; goal is to discharge from PT by the 12-week mark.
•Be sure to educate patient on continued healing and risk of re-injury
•At 12 weeks patient should be able to do the following with minimal pain:; full squat; full lunge
•Unilateral calf raise
•Return to sport (running, soccer, baseball/softball, volleyball, etc) at 6 months post-op.

GOALS Heel-raise progression

Return to Sport & Discharge Criteria

•Single-leg heel raise comparable to opposite side (height, reps, quality)
•Pain-free running progression; plyometrics only after adequate plantar-flexor strength
•Return to sport when cleared by Dr. Kelly (commonly 6–9+ months)

Time frames are guidelines — progress when phase goals are met, per Dr. Kelly and the treating therapist.

When to call

Increasing pain, numbness, redness, drainage from the wound, or fever/chills — call (509) 460-5588. After hours, the answering service can reach Dr. Kelly. If your issue feels emergent, call 911 or go to the nearest emergency department.

Physical therapists

Treating one of Dr. Kelly's patients? Download the printable protocol for your clinic, and call (509) 460-5588 with questions about an individual patient's progression.

⬇ Protocol PDF

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