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Practice Policy Update Regarding COVID-19

Achilles Tendon Repair

This protocol provides you with general guidelines for initial stage and progression of rehabilitation. Please note this protocol is a guideline. Specific changes will be made by the physician as appropriate for the individual patient.

Phase I: Weeks 0-2

General

  • Remain non weightbearing (NWB) using crutches/knee scooter
  • Patient in plantar flexion splint
  • Elevation and icing are encouraged to alleviate swelling

Exercises

  • Wiggle toes

Phase II: Weeks 2-4

General

  • Come into the office for splint and suture removal.
  • You will be placed into a CAM walker boot with three heel wedges
  • Touchdown WB (10% of body weight) using crutches/knee scooter

Exercises

  • Ankle pumps (dorsi/plantar flexion)

Phase III: Weeks 4-6

General

  • Advance to full WB gradually over 10-14 days (Increase 10% of body weight per day) in the boot
  • At Week 5: wean off of one heel wedge
  • At Week 6: wean off of the second heel wege

Exercises

  • Start physical therapy
  • Continue ankle ROM exercises

Phase IV: Weeks 6-12

Goals

  • Transition into sneakers with a heel lift
  • Safely progress with strengthening, proprioception, and gait training
  • Gradually return to regular functional activity
  • Restore full range of motion

General

  • Transition to sneaker

Phase V: Months 3-6

Goals

  • Safely progress with strengthening, proprioception, and gait training
  • May begin light jogging at 3-4 months
  • Running/Cutting at 4 months +
  • Return to sports at 5-6 months
  • Full activity as tolerated
  • Work or sport specific training

Return to full unrestricted activity or sports when cleared by a physician

General Post-Operative Care

Dressings

  • Maintain primary dressings until the two week mark post-surgery, unless otherwise instructed by your provider. 
  • Have a water proof cover available to protect your dressing or splint while in the shower.

Infection 

  • Observe for any signs of infection including redness, warmth, dehiscence or opening of the incision, or drainage at the incision site. Notify your provider right away if you experience any of these symptoms.

Pain Management 

  • Talk to your doctor about your pain medication regimen before and after surgery. Usually, prescription pain medications can be taken every 4-6 hours. OTC Tylenol can be taken for breakthrough pain, the maximum dose for Tylenol is 3,000 mg per day for adults.
  • OTC stool softeners may be taken concurrently with your prescription pain medication to reduce the risk for opioid induced constipation. 
  • Pain medications commonly have a side effect of drowsiness. Refrain from any activities that require strict attention after taking these medications (ie operating heavy machinery, driving, etc).

Swelling

  • Icing and elevating the affected extremity above the level of the heart can help alleviate swelling. Icing can be done 2-3 times a day or as needed.
  • Avoid applying the ice directly on your skin for a prolonged period of time as this may cause blisters. 

Range of Motion (ROM)

  • Once your splint is removed, Range of motion exercises are encouraged to reduce stiffness. 
  • In the ankle, ankle pumps (dorsiflexion and plantar flexion exercises) for 5-10 minutes about three times is encouraged. 
  • In the toe, flexion exercises of the joint are encouraged.

Deep Vein Thrombosis (DVT)

  • Talk to your provider about Prophylaxis treatment for Deep vein thrombosis (DVT) needed for your surgery.
  • Antiplatelet and anticoagulant medications can increase your risk for bleeding and bruising. 
  • If you experience any severe calf pain, leg swelling, along with chest pain and shortness of breath, call 911 or go to the nearest hospital as this can be a sign of a life threatening condition.