Rehabilitation after surgery for achilles tendon rupture

This page gives you information about what to expect from your early recovery. It is also intended as a guide for your longer-term rehabilitation after Achilles surgery, which you can use in conjunction with a physiotherapist from around 8 weeks after surgery.

After surgery
  • You will have a plaster backslab applied to your leg after surgery. This helps the surgical wound heal and supports the tendon repair.
  • You should be taking a blood thinning medication such as dalteparin to prevent blood clots.
  • Minimise your activity and elevate your foot.
  • Keep moving your toes, knee and hip, your achilles repair will be safe in
    plaster whilst you do this. ​

​​1-2 weeks after surgery
  • You will be seen in the clinic and changed to a removable vacoped boot.
  • You may start to walk on the repair in the boot with the boot fixed at 30 degrees
    on the scale at the back of the boot (fixed at number 3) .
  • You should not remove the boot at night.
  • Keep your knee, hip and toes moving.
  • You do not need other physio at this stage.
  • You may remove the boot each day from 2 to 8 weeks after surgery to bathe your foot, whilst keeping your toes pointed down. ​

2-8 weeks after surgery
  • Increase your walking, you do not need to use crutches if you are comfortable without.
  • At 4 weeks change the setting on the back of the boot using the boot key by one notch each day in order to reach 15 degrees (Between 1 and 2) by week 6. This only takes a few days but allows some movement in your achilles.
  • At 6 weeks change the setting on the back of the boot by one notch each day to achieve 0 degrees by week 8.
  • You can to change the boot to the smaller foot plate provided as your ankle becomes more mobile.
  • Continue to use the boot at night.
  • Continue blood thinning medication (dalteparin) until 4 weeks after surgery.
  • You will be reviewed in the clinic at between 6 and 8 weeks after surgery. 

8 weeks to 12 weeks
  • You should be wearing your boot when walking.
  • You may start physiotherapy to begin strengthening the calf muscle. 
  • You may start very gentle theraband exercises
  • Avoid over-stretching the calf muscle before 12 weeks after surgery.
  • Physio should focus on achieving a foot which can be comfortably placed flat
    to the floor. You should avoid strength work.

12 weeks to 14 weeks
  • You may be back in your normal shoes, but avoid completely flat shoes for another 6 weeks.
  • Physio should focus on weightbearing stretches, gait re-education and light
  • strengthening exercises e.g. seated calf raises or cautious theraband use.
  • You should avoid isolated single leg strength work.

14 weeks to 20 weeks
  • Continue to avoid single leg calf raises and impact activity (such as running).
  • Physio should focus on supported strengthening with exercises such as
    bilateral calf raises, cycling and walking (no incline), hamstring curls, small range lunges.
  •  Commence proprioceptice exercises such as single leg standing. ​

20 weeks to 8 months
  • Work on regaining normal movement.
  • Aim for achieving gastroc strength of 80% of the other side.
  • Return to jogging/running.
  • Work on increasing endurance and return to sport-specific activity.
  • Avoid single leg heel raises until 6 months post-injury.

8 months onwards
  • Active single leg heel raises .
  • Return to normal activity.
  • No restrictions on activity.
  • Work on regaining pre-injury strength. 
Picture
Toes pointed down, a safe position for washing your foot after achilles rupture