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Achilles Surgical Repair Rehabilitation

Phase I (0-2 weeks)                                                                                                               

Appointments

  • Home exercise program will begin after surgery – 2 weeks

  • 1-3x/wk. from 2-6 wks.

Rehabilitation Goals

  • Protection of the post-surgical repair.

  • Wound healing – Do no put pressure on the incision.

Precautions

  • Splint in plantarflexion for 2 weeks—strictly non-weight bearing.

  • Use crutches for mobilization.

  • Avoid dependent positioning of the foot to assist with wound healing.

Suggested Therapeutic Exercise

  • Quadriceps sets.

  • Straight leg raise 4 way.

Cardiovascular exercise

  • Upper body circuit training or upper body ergometer (UBE).

Progression Criteria

  • 2 weeks after surgery.

 

Phase II (weeks 2-4)

Appointments

  • Rehabilitation appointments are 1-3 times per week.

Rehabilitation Goals

  • Partial weight bearing in boot with plantarflexion wedge.

  • Protect the post-surgical repair.

  • Active dorsiflexion to neutral.

Precautions

  • Weeks 2-3 or 4 use boot with 20-30 degree wedge with TTWB and crutches.

  • Weeks 3-4 or 5 use boot with 10 degree wedge.

Suggested Therapeutic Exercise

  • Ankle ROM with dorsiflexion to neutral ONLY.

  • Pain free isometric ankle inversion, eversion, and plantarflexion.

  • Open chain hip and core strengthening.

Cardiovascular exercise

  • Upper body circuit training or UBE.

Progression Criteria

  • Six weeks after surgery

  • Pain-free dorsiflexion to 0 degrees.

  • No wound issues.

 

Phase III (week 6-8)

Appointments

  • Rehabilitation appointments 1-3xwk

Rehabilitation Goals

  • Normalize gait on level surfaces without boot or heel lift and no assist devices.

  • Single leg stand with good control for 10 seconds

  • Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion.

Precautions

  • Slowly wean from boot with wedges in shoes.

  • Wean from crutches and WBAT.

  • Do not overstress the repair.

Suggested Therapeutic exercises

  • Frontal and sagittal plane stepping drills (side step, cross-over step, grapevine step).

  • Active ankle ROM.

  • Gentle gastroc/soleus stretching.

  • Static balance exercises (begin in 2 foot stand, then 2 foot stand on balance board or narrow base of support and gradually progress to single leg stand).

  • 2 foot standing nose touches.

  • Ankle strengthening with resistive tubing.

  • Low velocity and partial ROM for functional movements (squat, step back, lunge).

  • Hip and core strengthening.

  • Pool exercises if the wound is completely healed.

Cardiovascular exercise

  • Upper extremity circuit training.

Progression Criteria

  • Normal gait mechanics without the boot

  • Squat to 30 degrees knee flexion without weight shift

  • Single leg stand with good control for 10 seconds.

  • Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion.

 

Phase IV (week 8 - 16 weeks)

Appointments

  • Rehabilitation appointments 1-3xwk.

Rehabilitation Goals

  • Normalize gait on all surfaces without boot or heel lift.

  • Single leg stand with good control for 10 seconds.

  • Active ROM between 15 degrees dorsiflexion and 50 degrees of plantarflexion.

  • Good control and no pain with functional movement, including step up/down, squat, and lunges.

Precautions

  • No movement compensation exercises.

  • Avoid post-activity swelling and pain.

  • Avoid impact activities.

Suggested Therapeutic exercises

  • Frontal and transverse plane agility drills (progress from low velocity to high, then gradually adding in sagittal plane drills)

  • Active ankle ROM.

  • Gastroc/soleus stretching.

  • Multi-plane proprioceptive exercises – single leg stand.

  • 1 foot standing nose touches.

  • Ankle strengthening – concentric and eccentric gastroc strengthening.

  • Functional movements (squat, step back, lunge).

  • Hip and core strengthening.

Cardiovascular exercise

  • Stationary bike, stair stepper, swimming, UBE

Return to work/sport

  • Normal gait mechanics without the boot on all surfaces

  • Squat and lunge to 70° knee flexion without weight shift

  • Single leg stand with good control for 10 seconds

  • Active ROM between 15° of dorsiflexion and 50° of plantarflexion

 

Phase V (Months 4-6)

Appointments

  • Rehabilitation appointments 1-2xwk

Rehabilitation Goals

  • Good control and no pain with sport/work movements.

Precautions

  • Post-activity soreness should resolve in 24 hours.

  • Avoid post activity swelling – compression socks

  • Avoid running with a limp.

Suggested Therapeutic exercises

  • Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to other and then 1 foot to same foot.

  • Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities.

  • Sport/work specific balance and proprioceptive drills.

  • Hip and core strengthening.

  • Stretching for patient specific muscle imbalances.

Cardiovascular exercise

  • Replicate sport/work activities.

Progression Criteria

  • Dynamic neuromuscular control with multi-plane activities, without pain and swelling.

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