THESTONECLINIC

ORTHOPAEDICSURGERY,SPORTSMEDICINEANDREHABILITATION
ACHILLESTENDONREPAIRPERCUTANEOUSOROPEN
PostOperativePhysicalTherapyProtocol

GeneralConsiderations:
Timeframesmentionedinthisprotocolshouldbeconsideredapproximatewithactualprogressionbased
uponclinicalpresentation,physicianappointmentsaswellascontinuedassessmentbythetreating
practitionershoulddictateprogress.
AvoidforcefulactiveandpassiverangeofmotionoftheAchillesfor1012weeks.
Carefullymonitorthetendonandincisionsformobilityandsignsofscartissueformation.Regularsoft
tissuetreatments(i.e.scarmobilizationandfrictionmassage)todecreasefibrosis.
Nodirectscarmobilizationatsurgicalportalsuntil4weekspostoperative,notouchzone2inches
fromportals.Seewoundcareprotocolforfulldetails.
Allexercisesshouldbecarefullyobservedforanysignsofcompensationorguarding.
Norunning,jumping,orballisticactivitiesfor6months.
Aerobicandgeneralconditioningthroughouttherehabilitationprocess.
M.D./nurseappointmentsatDay12,Day14,1month,3months,6months,and1yearpostop.

03weeks:
AppointmentwithnurseDay2fordressingchangeandreviewhomeprogram.
AppointmentwithnurseDay14forstitchremoval.
Adjustablebootlockedoutat30degreesofplantarflexion.
Nonweightbearingfor3weeksnopushoffortoetouchwalking.
Painandedemacontrol(i.e.cryotherapy,electricstimulation,softtissuetreatments).

Manual:Softtissuemobilizationtoankle/foot/effleurageforedema.
Avoiddirectpalpationtosutureline(keep2inchnotouchzonearoundportalsx4weeks).

Exercise:Toecurls,toespreads,gentlefootmovementinboot,straightlegraises,kneeflexion/extension.
Welllegcycling,weighttraining,andswimmingforcardiovascular.
Goals:
Decreasepain,edema.
Gaitnonweightbearingwithaxillarycrutches/boot.

38weeks:
Walkingorthosissetat30degreesplantarflexionat3weeksadjust10degreesperweek.
Graduallyincreaseweightbearingfromtoetouchdowntopartialastoleratedandasableperrangeof
motion(heelcontactoncepartialweightbearing).
After6weeks,okaytoprogresstofullweightbearing.

Manual:Softtissuemobilizationtoankle,foot,effleurageforedema.
Initiategentlepassiverangeofmotiondorisflexion(notpastneutral),inversion,eversionper
tolerancecautiousforpercutaneus,openrepairmorestable.

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3727BUCHANANSTREET,SANFRANCISCO,CA94123
Tel.:(415)5633110.Fax:(415)5633301.Email:kstonemd@stoneclinic.com



THESTONECLINIC
ORTHOPAEDICSURGERY,SPORTSMEDICINEANDREHABILITATION
ACHILLESTENDONREPAIRPERCUTANEOUSOROPEN
PostOperativePhysicalTherapyProtocol

At4weeksinitiatescarmobilizationonceincisionscompletelyclosed.

Exercise:Straightlegraises,sidelyinghipabduction,Straightleggedbridges.
Isometricsofuninvolvedmuscles
LightactivedorsiflexionoftheankleuntilgentlestretchofAchillesafter4weeks
SlowlyincreasetheintensityandrangesofisometricsofAchilleswithintherangeoftheboot.
SlowlyincreasepassiverangeofmotionandstretchontheAchillesafter6weeks.
Proprioceptionexercises,intrinsicmusclestrengthening,PNFpatternsforhipandknee(nottoAchilles).
At6weeks,okaytoaddstationarycyclingwithheelpushonly.

Goals:
0degreesDorsiflexion.
After6weeksprogresstofullweightbearing,dischargecrutches.

812weeks:
After8weeks,okaytowearshoeswithaheel(i.e.cowboyboots,1/4"heelliftinshoes).
Fullweightbearingwithheelliftastolerated,gaittraining.
Weanintoaregularshoeovera24weekperiod.

Manual:Continuewithsofttissuemobilization,rangeofmotion,jointmobilizationsasneeded.

Exercise:Beginandgraduallyincreaseactive/resistiveexercisesoftheAchilles(i.e.submaximalisometrics,
cautiousisotonics,Theraband).
progresstocyclinginshoe,swimming(nofins).
Goals:
Fullrangeofmotionankle.
Tolerancetoregularshoe,goodgaitmechanics.

36months:
Weanoffheellifts(ifnotalready).
CompleteSportTest1.

Exercise:Closedchainexercises:controlledsquats,lunges,bilateralcalfraise(progresstounilateral),toeraises,
controlledsloweccentricsvs.bodyweight.
Cycling,VersaClimber,rowingmachine,NordicTrack(gradually).
Unlessexcessivefibrosispresent,shouldbedischargedintoahomeprogram.
Goals:
CompleteandpassSportTest1.Strength5/5.
Abletoperformsinglelegcalfraise.

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3727BUCHANANSTREET,SANFRANCISCO,CA94123
Tel.:(415)5633110.Fax:(415)5633301.Email:kstonemd@stoneclinic.com



THESTONECLINIC
ORTHOPAEDICSURGERY,SPORTSMEDICINEANDREHABILITATION
ACHILLESTENDONREPAIRPERCUTANEOUSOROPEN
PostOperativePhysicalTherapyProtocol

6months:
CompleteSportTest2.
Progresstrainingjogging/running,jumpingandeccentricloadingexercises,noncompetitivesporting
activities,sportssimulatedexercises.

89months:
Returntophysicallydemandingsportand/orwork.

[Typetext]
3727BUCHANANSTREET,SANFRANCISCO,CA94123
Tel.:(415)5633110.Fax:(415)5633301.Email:kstonemd@stoneclinic.com