0 – 2 WEEKS

• Aircast boot with 2 cm heel lift

• WBAT (Weight Bearing As Tolerated) – crutches as needed

2 – 4 WEEKS

• Aircast boot with 2 cm heel lift

• WBAT – crutches as needed

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

• Modalities to control swelling

• Knee/hip exercises as appropriate

• NWB (Non-Weight Bearing) fitness/cardio work

• Hydrotherapy (within motion and weight-bearing limitations)

4 – 6 WEEKS

• Aircast boot with 2 cm heel lift

• WBAT

• Continue treatment as per 2–4 weeks

6 – 8 WEEKS

• Aircast boot

• Discontinue heel lift

• WBAT

• Dorsiflexion stretching, slowly

• Graduated resistance exercises (OKC, CKC, functional)

• Proprioceptive and gait retraining

• Modalities as indicated

• Fitness/cardio to include WBAT

• Hydrotherapy

8 – 12 WEEKS

• Wean off boot

• Return to crutches/cane as necessary; then wean off

• Continue to progress ROM, strength, proprioception

>12 WEEKS

• Continue to progress ROM, strength, proprioception

• Retrain strength, power, endurance

• Increase dynamic WB exercise, include plyometric training

• Sport specific retraining

Key Points

• Early functional rehab reduces re-rupture rates compared to prolonged casting.

• Protocol should be individualized—age, activity level, and surgical vs. non-surgical care all influence progression.

• Close follow-up with the treating physician and physical therapist is essential.

References:

1. Willits K, Amendola A, Bryant D, et al.
   Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.
   J Bone Joint Surg Am. 2010;92(17):2767–2775.
   ➝ Landmark RCT showing early functional rehab is safe and reduces rerupture risk.

2. American Orthopaedic Foot & Ankle Society (AOFAS).
   Position Statement: Achilles Tendon Rupture Rehabilitation Protocols. 2021.
   ➝ Supports accelerated rehab with early weight-bearing and motion when monitored.

3. Kearney RS, Parsons N, Costa ML.
   Achilles tendon rupture rehabilitation: a mixed methods study of current practice among orthopaedic surgeons in the United Kingdom.
   Physiotherapy. 2012;98(4):319–326.
   ➝ Surveys current clinical rehab approaches, emphasizing early mobilization.

4. Maffulli N, Oliva F, Maffulli GD, Buono AD, Gougoulias N.
   Achilles tendon ruptures: an update on basic science and clinical management.
   Br Med Bull. 2020;133(1):115–131.
   ➝ Comprehensive review of biology and clinical outcomes supporting functional rehab.

5. Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M.
   Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials.
   J Bone Joint Surg Am. 2012;94(23):2136–2143.
   ➝ Meta-analysis confirming similar outcomes between operative and non-operative care when accelerated rehab is applied.

6. Heikkinen J, Lantto I, Flinkkilä T, et al.
   Augmented compared with nonaugmented surgical repair after total Achilles rupture: results of a prospective randomized trial with thirteen or more years of follow-up.
   J Bone Joint Surg Am. 2016;98(2):85–92.
   ➝ Long-term evidence for outcomes and safety of functional rehab protocols.