Rehab Protocol

Week 1 (May 3 – May 9)

  • In splint
  • NWB (Non Weight Bearing)

Week 2 (May 10 – May 16)

  • Sutures remain
  • Placed in boot with heel lifts
  • ROM (Range of Motion) full PF to 10 degrees PF
  • NWB

Week 3 (May 17 – May 23)

  • Sutures removed
  • Inversion/eversion/circumduction
  • Still limited to 10 degrees PF
  • Isometrics
  • Gentle scar manipulation
  • Continue NWB in boot with heel lifts

Week 4-6 (May 24 – June 6)

  • Begin PWB FWB in boot with heel lift 33% Body weight per week to FWB Week 6
  • Isometric
  • Theraband exercises
  • Gentle exercises bicycle with pedal under heel
  • Active ROM with knee flexed to neutral
  • Scar mobilization

Week 7-8 (June 7 – June 20)

  • Continue FWB in boot removing 2 wedges each week until using none
  • Balance board and proprioceptive exercises
  • Stationary bike
  • Continue scar mobilization and stretching to neutral

Week 9-10

  • FWB in clogs (shoe with higher heel)
  • Begin double legged toe raises
  • Balance board and proprioceptive exercises
  • Stationary bike
  • Continue scar mobilization and stretching to neutral

Week 11-12

  • Progress to regular shoes
  • Treadmill
  • Continue double legged toe raises
  • Balance board and proprioceptive exercises
  • Stationary bike
  • Continue scar mobilization and stretching to neutral

Week 12 plus

  • Begin single legged toe raises as tolerated
  • Stretching past neutral
  • Treadmill walk jog program
  • Add cutting exercises 4-5 months
  • Running allowed at 5-6 months
  • No explosive jumping, tennis, racquetball, and squash etc. until 1 year out

2 Responses to Rehab Protocol

  1. OK, Andrew, I see your protocol now.

    The good news is that you’ve got one at all, which puts you in the top 1 or 2% of the ATR community, based on my casual survey of bloggers at http://www.achillesblog.com.

    The bad news is that it does seem to be much slower than the protocol that was statistically proven to produce excellent results (with or without surgery) in the brand-new study from UWO, and the 3 prior studies dating back to 2007. (All linked from my blog at http://www.achillesblog.com/normofthenorth .)

    In addition to a later transition to PWB — yours is after 3 wks and UWO is after 2 — you’ll wait until after 5 weeks for FWB, while UWO is full “WBAT” after 4. (That’s not a huge difference, I admit!)

    Your transition to the “neutral” position (no heel lifts) comes after 7-9 weeks (depending on how you “count” clogs with higher heels), and UWO’s/mine came after 6 weeks. You don’t get into regular shoes until 10 weeks in, UWO and I did that at 8 weeks in (though I used a hinged boot as a transition, starting at 7 weeks in and off-and-on for another couple of weeks).

    Your exercise and stretching schedule is also slower than UWO’s/mine. (BTW, if you CAN do 1-legged heel raises soon after Week 12, (a) Go to the head of the class! and (b) DO NOT overdo! 8 yrs ago, post-op for my first ATR, I did, and I lost a full MONTH of rehab time!)

    One of the biggest difference in the protocols is in the last line of your protocol, banning high-risk stop-and-start and jumping sports for a full year. That’s just MEAN! When I tore my first ATR (Nov. 2001), I got surgery from an Ortho Surgeon who told me he was a “conservative guy” so often that I wanted to wring his neck. But even HE said I could go back to competitive Volleyball as soon as I could do a bunch of 1-legged heel raises without grunting. My season didn’t start until after about 10 months, and I was “there”, so I played and it was great and I was very quickly back to my pre-ATR level of play, no problems. (I might have been “there” even a month or 2 or 3 sooner, but I was too busy sailing and bicycling to care, until the indoor volleyball season started.)

    Restricting your return to the sports you love based on somebody’s calendar — and making it a full 12 months post-op — seems like Cruel and Unusual Punishment to me.

    BTW, UWO’s/my protocol is at http://achillesblog.com/normofthenorth/the-non-surgical-protocol-ive-been-following/ . It’s a little vague on the return to high-risk sports, since it peters out at “>12 weeks”. Here’s that final listing:
    >12 WEEKS
    -continue to progress ROM, strength, proprioception
    -retrain strength, power, endurance
    -increase dynamic WB exercise, include plyometric training
    -sport specific retraining

    That apparently leaves it open to “negotiation” with your Doc and your PT, after 12 weeks or so. Mind you, plyometric training is pretty high-risk activity for an AT, as is lots of sport-specific retraining.

    You’re >30 years younger than I was when I tore my first ATR and returned to high-risk sports, with total success, 2 months earlier than your protocol says you should. What is wrong with this picture?

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