Achilles Repair Protocol
Applicability:PhysicianPractices
DateEffective:12/2016
Department:RehabilitationServices
DateLastReviewed/or
DateLastRevision:
12/2016
Supersedes:
Purpose:DefinetheprotocoltobefollowedforallpatientsreferredfromNorthwestern
Orthopedicsaftertheaboveprocedurehasbeenperformed.
PolicyStatement:TreatmentwillfollowthedefinedprotocolbelowandbecarriedoutbyPhysical
Therapist,AthleticTrainerand/orPhysicalTherapyAssistants.
Background:N/A
Definitions:N/A
Procedure:
PHASEI0-2Weeks
NWBwithassistivedevicex2weeks
Immobilizationinsplint
PHASEII2-6weeks
BeginoutpatientPhysicalTherapy(following2weekMDfollowupforremovalofsplint)
Camboot:setat15°byMDatweek2
Setat7.5°byPTatweek4
Gait:PWB50%withCambootandappropriateassistivedevice
Precautions:
NOpassivedorsiflexion,noactiveplantarflexion
Gentlesofttissuemobilizationandscarmassageonceincisionhashealed
EdemaControl:
Ice/cryocuff
Elevation
Tensogrip/kinesiotape
ESTIMasindicated
Suggestedexercises:
ROM:
Activedorsiflexiontotolerance
Passiveplantarflexiontotolerance
Activeandpassiveinversionandeversion
KneeandhipAROMandstrengtheningopenchain
Optionalat4weeks-aquaticther-ex(onceincisionhashealed),WBATinchestdeepwater,no
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resistanceorpassivestretchingofgastroc/achillies
PHASEIII6-12weeks
Camboot:setat0°byPTat6weeks
WeanfromCambootat8-9weeksandeducateinproperfootwear(mayneedwideheel
countertominimizepressureonincision)
Gait:FWBat6weeksifincisionhealed
Gentlesofttissuemobilizationandscarmassageonceincisionhashealed
SuggestedExercises:
Beginstrengthening
AROMinalldirections
GentlepassiveAchillesstretching Continuestrengtheninghip,kneeandcore
Stationarybikewithoutresistance
PHASEIV12-16weeks
ROM/stretchingAchillesasneeded
Gait:Ensuregoodgaitpattern:heel-toegait,goodheelstrikeandpush-off,stance
timeequallefttoright
Suggestedexercises:
BalanceandProprioceptionactivities
Progressanklestrengthening
Beginfunctionalstrengtheningexercises
Legpress-bilateral
Legpresstoesraises(bilateral,progresstounilateral)
Softtissueandjointmobsasneeded
Stairmaster,bikeforcardio
Criteriatoprogress:
ROMequaltooppositeside
Controlledinflammation
Nopain
Plantarflexorstrength4/5(perform10partialtofulltoesraises)
PHASEV16-20weeks
Suggestedexercises:
Progresspreviousexercises:hipandkneePRE’s
ProgresstoWBunilateralheelraises
Stairmaster
Beginjumpingprogression:squattoheelraiseatslowspeed,legpress,min-tramp,ground
Functionalrehab
Forwarddips(dipdownfromstair)multipleplaneforbalance
Beginlightplyometricactivities
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Criteriatoprogress:
ROMequaltooppositeside
Perform20unilateraltoesraises(fullrange,pain-free)
Performbilateraljumpinginplace30secondseachF/B,L/Rwith
goodtechnique
PHASEVI:5-6monthspost-op
SuggestedExercises:
Progresspreviousexercises
Progressjumpingtohopping
Beginjogging/runningwhenhoppingisperformedwithgoodtechnique
Sportspecificdrillsforappropriatepatients
Criteriatodischargenon-athletes:
Goodgaitpattern
ADL’swithoutdifficulty
Gastroc/soleus4+-5/5strength
Criteriatodischargeathletes:
Goodgaitpattern
Patientperformsthefollowingtestswithin80%oftheuninvolvedleg:
Hopfordistance
Singlelegbalancereach
Maintenanceprogramshouldstresscontinuedstrengthandenduranceworkatleast2-3
timesperweek.
NoteWell:VarianceswillbecommunicatedbythesurgeondirectlytoRehabilitationServices. MonitoringPlan:Willbereviewedyearly
RelatedPolicies:N/A
References:N/A
Reviewers:
A. KeyStakeholders:MichaelBarnumMD,OrthoMedicalDirector
B. Committees:N/A
C. KeyProcessOwner(KPO):KristyCushing,ManagerRehabServices
D. AdministrationApproval:AmyPutnam,VPPhysicianServices
Not part of policy:
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