TABLE E-1 Achilles Tendon Rupture Rehabilitation Protocol

Time Frame Activity

0-2 weeks Posterior slab/splint; non-weight-bearing with crutches: immed. postop. in surgical

group, after injury in nonop. group

2-4 weeks Aircast walking boot with 2-cm heel lift*†

Protected weight-bearing with crutches

Active plantar flexion and dorsiflexion to neutral, inversion/eversion below neutral

Modalities to control swelling

Incision mobilization modalities‡

Knee/hip exercises with no ankle involvement; e.g., leg lifts from sitting, prone, or

side-lying position

Non-weight-bearing fitness/cardiovascular exercises; e.g., bicycling with one leg,

deep-water running

Hydrotherapy (within motion and weight-bearing limitations)

4-6 weeks Weight-bearing as tolerated*†

Continue 2-4 week protocol

6-8 weeks Remove heel lift

Weight-bearing as tolerated*†

Dorsiflexion stretching, slowly

Graduated resistance exercises (open and closed kinetic chain as well as functional

activities)

Proprioceptive and gait retraining

Modalities including ice, heat, and ultrasound, as indicated

Incision mobilization‡

Fitness/cardiovascular exercises to include weight-bearing as tolerated; e.g., bicycling,

elliptical machine, walking and/or running on treadmill, StairMaster

Hydrotherapy

8-12 weeks Wean off boot

Return to crutches and/or cane as necessary and gradually wean off

Continue to progress range of motion, strength, proprioception

>12 weeks Continue to progress range of motion, strength, proprioception

Retrain strength, power, endurance

Increase dynamic weight-bearing exercise, include plyometric training

Sport-specific retraining

*Patients were required to wear the boot while sleeping. †Patients could remove the boot for bathing and