0 – 2 Weeks Post Operatively
Plaster front slab placed on while under anaesthetic, in minimal equinus (foot pointing down)
Touch-weight-bearing mobilization with 2 crutches
Regular pain relief as required (Eg. Paracetamol, Coedine and Diclofenac)
Keep plaster dry
Strict elevation at the level of the heart, for 23 hours a day for 7 days (for pain relief and wound healing)
Elevation at the level of the heart, for 12 hours a day for 7 further days

After 2 Weeks Post Operatively (Post Operative Week 3)
Outpatient visit – Seen by Mr Gordon
Plaster front slab removed, wound inspected and stitches removed
Rigid walking boot (eg. Air Select Standard walking boot by Aircast) with 3 x heel wedge inserts fitted (ankle movements protected)
Start full weight-bearing (as much weight as comfortable). (Early weight bearing has been shown to statistically improve time to return to activities including work, sports, and normal walking)
Start physiotherapy – at home and in outpatients (see below)

After 2 – 8 Weeks Post Operatively
Boot can be removed for physiotherapy, when seated, for bathing, but when off, no weight through foot
At all other times, boot must remain on including for sleep.
After 5 weeks the boot can be removed for sleep, but replaced if weight bearing during the night

AirSelect Standard Long Walking Boot and Wedges		Evenup device to equalise leg lengths while wearing Airselect boot

Start of 5th Post Operative Week – Patient removes 1 x heel-lift insert (2 remaining)
Start of 7th Post Operative Week – Patient removes 1 x heel-lift insert (1 remaining)
Start of 9th Post Operative Week (ie. 8 weeks Post Operatively)

8 Weeks Post Operatively
Outpatient visit – Seen by Mr Gordon
Assessment of tendon healing, ankle motion, calf power, gait
Discard boot and into normal shoe full weight bearing
Continue physiotherapy

3 Months Post Operatively
Outpatient visit – Seen by Mr Gordon
Assessment of tendon healing, ankle motion, calf power, gait, discuss sporting aspirations
Continue physiotherapy
Start jogging

6 Months Post Operatively
Outpatient visit – Seen by Mr Gordon
Assessment of tendon healing, ankle motion, calf power, gait, discuss sporting aspirations
Continue physiotherapy if required
Start sports requiring explosive activities

Driving
You need to be able to control the vehicle in an emergency. Can you stamp your foot down on the ground? For left sided surgery and no clutch is required, driving is probably safe at 2 weeks post operatively. For right sided surgery, driving is probably safe at 9 weeks post operatively, once in a normal shoe. If you are unsure, please ask Mr Gordon.

Return to Sport
There is a lack of evidence to recommend specific timings for returning to sport. A decision should be made with in consultation with Mr Gordon and your physiotherapist. Above timings are guidelines only.

Rehabilitation Guide for Physiotherapists

Post Operative Week 3 & 4
Soft tissue massage
Out of boot : Passive range of motion, gentle active plantar flexion, limit dorsiflexion to gravity in prone position
Exercise bike with boot on

Post Operative Week	Support	Weight Bearing Status
1	Plaster	Touch weight bear
2	Plaster	Touch weight bear
3	Boot – 3 heel raises (22⁰)	Full weight bear
4	Boot – 3 heel raises (22⁰)	Full weight bear
5	Boot – 2 heel raises (16⁰)	Full weight bear
6	Boot – 2 heel raises (16⁰)	Full weight bear
7	Boot – 1 heel raises (10⁰)	Full weight bear
8	Boot – 1 heel raises (10⁰)	Full weight bear
9	Normal Shoe	Full weight bear

Rehabilitation Summary. Operation occurs on first day of ‘Post Operative Week 1’
(x⁰ = Degrees of plantar flexion using Aircast heel raises)

Post Operative Week 5 – 8
Active plantar flexion with Theraband
Seated heel raises
Out of boot : Full plantar flexion, inversion and eversion, limit dorsiflexion to number of heel raises in degrees (see Rehabilitation Summary table)
Proprioception/balance, Gait re-education

Post Operative Week 9 onward (boot discarded)
Gentle weight bearing dorsiflexion stretch (lunge position)
Eccentric/Concentric loading (bilateral to single. Emphasise eccentric phase)
Single stairs
Progress to upslope and downslope
NWB aerobic exercises – e.g. cycling (push with heel, not toes).
Monitor inflammation signs and rehabilitation accordingly
Discard crutches (if still needed) when dorsiflexion 10⁰

3 Months Post Operatively
Jogging progressing to fast acceleration & deceleration
Directional running / cutting
Pylometrics. e.g. toe bouncing upwards / forwards /directional

Aircast AirSelect

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Reference List
Cetti, R., L. O. Henriksen, and K. S. Jacobsen. “A new treatment of ruptured Achilles tendons. A prospective randomized study.” Clin.Orthop.Relat Res.308 (1994): 155-65.

Costa, M. L., et al. “Immediate full-weight-bearing mobilisation for repaired Achilles tendon ruptures: a pilot study.” Injury 34.11 (2003): 874-76.

Kangas, J., et al. “Early functional treatment versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study.” J.Trauma 54.6 (2003): 1171-80.

Maffulli, N., et al. “Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the achilles tendonrch this journal.” Am.J.Sports Med. 31.5 (2003): 692-700.

Mortensen, H. M., O. Skov, and P. E. Jensen. “Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study.” J.Bone Joint Surg.Am. 81.7 (1999): 983-90.

Suchak, A. A., et al. “Postoperative rehabilitation protocols for Achilles tendon ruptures: a meta-analysis.” Clin.Orthop.Relat Res. 445 (2006): 216-21