Percutaneous Achilles Repair Guidelines

• Follow up visit 5 days after surgery - remove splint, plantigrade cast placed
• 2 week follow-up - suture removal - new cast placed
• 4 weks postop - cast removal, boot application with heel wedges (30 deg) and initiate WBAT
• 6 weeks postop - remove 1 wedge (re move 2nd @ 2 weeks later), continue WBAT
• 8 weeks: follow-up, d/c boot to regular shoe
• 12 weeks: begin isokinetic strengthening, heel raises

Weeks 9 - 12

• KEYS: no passive DF stretching, progress cyclic muscle strengthening, stress PF end range strengthening, d/c heel lifts
• Gait training: marching &lateral walking
• Stairmaster
• Retro-treadmill
• Calf raises with eccentric lowering
• Single leg balance (baps, decline board)
• Steps - lateral step ups 6 - 8 inches, descend 4 inches step
• Isokinetics (concentric , eccentric)
• End range strengthening (bilateral decline board, prone isometric/isotonics, legg press calf raises
• GOALS: restore normal gait, full active PF and DF
• Continue to progress gastroc-soleus strength

Weeks 13 - 20

• KEYS: initiate passive DF stretching, progress full ROM, stress PF end range strengthening, functional training
• Jogging and retro jogging
• End-range PF strengthening (single limb decline board calf raise)
• Jump progression (single leg press hopping, land on forefoot ->bilateral mini-hops -> unilateral mini-hops @ week 20)
• Tramp hopping
• Forawer/lateral stopovers
• Sub-max agility training (figure-8, karaoke, shuffles)
• Regular biking
• GOALS: cross-over stair descent, jogging, full ROM

Weeks 20+

• KEYS: full ROM strengthening, functional training
• Plyometrics
• Running/agility drills
• Return to sport (6 months minimum, sport specific)

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