Orthopaedic Surgeon
Achilles Surgical Repair Rehabilitation
Phase I (0-2 weeks)
Appointments
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Home exercise program will begin after surgery – 2 weeks
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1-3x/wk. from 2-6 wks.
Rehabilitation Goals
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Protection of the post-surgical repair.
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Wound healing – Do no put pressure on the incision.
Precautions
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Splint in plantarflexion for 2 weeks—strictly non-weight bearing.
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Use crutches for mobilization.
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Avoid dependent positioning of the foot to assist with wound healing.
Suggested Therapeutic Exercise
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Quadriceps sets.
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Straight leg raise 4 way.
Cardiovascular exercise
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Upper body circuit training or upper body ergometer (UBE).
Progression Criteria
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2 weeks after surgery.
Phase II (weeks 2-4)
Appointments
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Rehabilitation appointments are 1-3 times per week.
Rehabilitation Goals
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Partial weight bearing in boot with plantarflexion wedge.
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Protect the post-surgical repair.
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Active dorsiflexion to neutral.
Precautions
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Weeks 2-3 or 4 use boot with 20-30 degree wedge with TTWB and crutches.
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Weeks 3-4 or 5 use boot with 10 degree wedge.
Suggested Therapeutic Exercise
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Ankle ROM with dorsiflexion to neutral ONLY.
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Pain free isometric ankle inversion, eversion, and plantarflexion.
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Open chain hip and core strengthening.
Cardiovascular exercise
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Upper body circuit training or UBE.
Progression Criteria
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Six weeks after surgery
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Pain-free dorsiflexion to 0 degrees.
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No wound issues.
Phase III (week 6-8)
Appointments
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Rehabilitation appointments 1-3xwk
Rehabilitation Goals
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Normalize gait on level surfaces without boot or heel lift and no assist devices.
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Single leg stand with good control for 10 seconds
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Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion.
Precautions
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Slowly wean from boot with wedges in shoes.
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Wean from crutches and WBAT.
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Do not overstress the repair.
Suggested Therapeutic exercises
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Frontal and sagittal plane stepping drills (side step, cross-over step, grapevine step).
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Active ankle ROM.
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Gentle gastroc/soleus stretching.
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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).
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2 foot standing nose touches.
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Ankle strengthening with resistive tubing.
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Low velocity and partial ROM for functional movements (squat, step back, lunge).
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Hip and core strengthening.
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Pool exercises if the wound is completely healed.
Cardiovascular exercise
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Upper extremity circuit training.
Progression Criteria
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Normal gait mechanics without the boot
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Squat to 30 degrees knee flexion without weight shift
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Single leg stand with good control for 10 seconds.
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Active ROM between 5 degrees of dorsiflexion and 40 degrees of plantarflexion.
Phase IV (week 8 - 16 weeks)
Appointments
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Rehabilitation appointments 1-3xwk.
Rehabilitation Goals
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Normalize gait on all surfaces without boot or heel lift.
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Single leg stand with good control for 10 seconds.
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Active ROM between 15 degrees dorsiflexion and 50 degrees of plantarflexion.
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Good control and no pain with functional movement, including step up/down, squat, and lunges.
Precautions
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No movement compensation exercises.
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Avoid post-activity swelling and pain.
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Avoid impact activities.
Suggested Therapeutic exercises
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Frontal and transverse plane agility drills (progress from low velocity to high, then gradually adding in sagittal plane drills)
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Active ankle ROM.
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Gastroc/soleus stretching.
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Multi-plane proprioceptive exercises – single leg stand.
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1 foot standing nose touches.
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Ankle strengthening – concentric and eccentric gastroc strengthening.
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Functional movements (squat, step back, lunge).
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Hip and core strengthening.
Cardiovascular exercise
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Stationary bike, stair stepper, swimming, UBE
Return to work/sport
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Normal gait mechanics without the boot on all surfaces
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Squat and lunge to 70° knee flexion without weight shift
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Single leg stand with good control for 10 seconds
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Active ROM between 15° of dorsiflexion and 50° of plantarflexion
Phase V (Months 4-6)
Appointments
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Rehabilitation appointments 1-2xwk
Rehabilitation Goals
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Good control and no pain with sport/work movements.
Precautions
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Post-activity soreness should resolve in 24 hours.
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Avoid post activity swelling – compression socks
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Avoid running with a limp.
Suggested Therapeutic exercises
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Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to other and then 1 foot to same foot.
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Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities.
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Sport/work specific balance and proprioceptive drills.
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Hip and core strengthening.
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Stretching for patient specific muscle imbalances.
Cardiovascular exercise
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Replicate sport/work activities.
Progression Criteria
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Dynamic neuromuscular control with multi-plane activities, without pain and swelling.