Rehabilitation after surgery for achilles tendon rupture
This document 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 boot with wedges.
• You may start to walk on the repair in the boot with wedges.
• 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 weeks to 8 weeks after surgery

• Increase your walking, you do not need to use crutches if you are comfortable without.
• Continue to use the boot at night.
• Continue blood thinning medication (dalteparin) until 4 weeks after surgery.
• If you start with 5 wedges in your boot, remove one each week from the start
  of week 3, so there are none left at 8 weeks.
• If you start with 3 larger wedges in your boot, remove one at the start of
  week 3, one at the start of week 6 and one at the start of week 8.
• 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.
• Avoid 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.