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

    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 .)

    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 . 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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