Achilles Tendon Repair Protocol

Name: Achilles Tendon Repair Protocol
Creator: HEP Drop

Achilles repair rehab protocol after surgery, by week to 12 months: boot and heel wedges, weight bearing, phases and criteria, heel-rise tests for running and return to sport, with cited sources and a free printable PDF.

By HEP Drop staff · Reviewed by a licensed physical therapist, Oct 2026 · Version 2026.10 · 28 sources · How we write protocols

Written for surgical repair of an acute rupture. Non-operative care uses a similar boot plan, a little slower, and is not covered here^{[19, 20]}.

At a glance (Surgical repair): Splint wk 0–2 · WBAT in the boot from wk 2 · 3 wedges out one every 1–2 wk · full in the boot typically wk 4 · no DF past neutral to wk 8 · shoe with a heel lift typically wk 6–8 · running from wk 12 once criteria are met · sport from 6 mo. Criteria-based, test-gated.

Timeline

Currently showing: Surgical repair · Version 2026.10

Timeline, weeks 0–52 after surgery. Select any bar for details. Key dates are also in the key milestones table. The first 12 weeks are also shown week by week.

Phase

Weight bearing

Boot

Motion

Strength

Care

Restrictions

Milestones

First 12 weeks ↓

First 12 weeks

Weeks 0–12 after surgery, one tick a week, so the short early steps can be read. Select any bar for details.

Phase

Weight bearing

Boot

Motion

Restrictions

Milestones

Phase 1 · Protect the repair

wk 0–2

DVT is common on ultrasound screening (about 30%) whatever the rehab; low loading was a risk factor^[4].

Tell the surgeon at once about a fall or slip^{[4, 6, 11]}, a sudden rise in resting dorsiflexion^{[1, 6]}, or calf pain, warmth or new swelling^[1].

Goals

Protect the repair and the wound^[1]
Control swelling: elevation and cold^[1]
Keep the hip and knee strong^[1]

Allowed

Toe, knee and hip exercises in the splint^{[5, 1]}
Submaximal calf isometrics inside the splint or boot, pain-free^[1]

Avoid

Dorsiflexion past neutral (until wk 8)
Calf stretching (until wk 12)
Walking without the boot (until wk 6)
Driving until the surgeon has cleared it (no source gives a week)
Pool or soaking (one compared protocol) until the wound has healed^[26]

Advance to Phase 2 when

Wound healed^[1] (yes/no check)
Surgeon clears loading in the boot^[1]

Exercises

Quad Set2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Active Straight Leg Raise with Quad Set, start

Active Straight Leg Raise with Quad Set, finish

Active Straight Leg Raise with Quad Set2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Hip Abduction (Side-Lying)2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Prone Hip Extension2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Toe Yoga2–3 × 10–15 (sets/reps: our default)See it in HEP Drop →

Isometric Ankle Plantarflexionsubmaximal, pain-freeSee it in HEP Drop →

How protocols differ: The compared protocols use a splint for the first 1 to 2 weeks; one casts to wk 6^{[25, 24, 26, 27]}.

Create HEP for Phase 1 →Match the surgeon's protocol →Opens HEP Drop · Free during early access

Key milestones by week

How this protocol compares with published Achilles repair protocols, on a shared week scale (return to sport on a 12-month scale). Criteria-based: advance only when each phase's criteria are met.

Want the patient's dates here? (or weeks post-op).

This protocol vs published protocols · Surgical repair
Milestone	This protocol	0816243252 wk Range in published protocols	Published range
Out of the boot	wk 6		wk 6–16^{[24, 25, 26, 27]}two of four by wk 8
Full weight bearing	wk 4		wk 6–12^{[24, 25, 27]}three give a week: wk 6, wk 6–11, wk 8–12
Running	wk 12		wk 14 to 6 mo^{[24, 25, 27]}three give a week: wk 14, 3.5 mo, 4+ mo
Return to sport	from 6 mo	months scale: 0–12 mo	24 wk to 6+ mo^{[24, 25]}two give a time: 24 wk and 6+ mo

Range in published protocolsMost commonThis protocol

All phases

⬇ Download PDFDownload PDF / Print protocol: your clinician copy, no email needed. Create HEP: a patient handout in HEP Drop with that phase's exercises prefilled. Opens HEP Drop · Free during early access.

Phase 1 · Protect the repair

wk 0–2Create HEP for Phase 1 →

Allowed

Toe, knee and hip exercises in the splint^{[5, 1]}
Submaximal calf isometrics inside the splint or boot, pain-free^[1]

Avoid

Dorsiflexion past neutral (until wk 8)
Calf stretching (until wk 12)
Walking without the boot (until wk 6)
Driving until the surgeon has cleared it (no source gives a week)
Pool or soaking (one compared protocol) until the wound has healed^[26]

Exercises

Quad Set2–3 × 10–15 (sets/reps: our default)

Active Straight Leg Raise with Quad Set2–3 × 10–15 (sets/reps: our default)

Hip Abduction (Side-Lying)2–3 × 10–15 (sets/reps: our default)

Prone Hip Extension2–3 × 10–15 (sets/reps: our default)

Toe Yoga2–3 × 10–15 (sets/reps: our default)

Isometric Ankle Plantarflexionsubmaximal, pain-free

Advance to Phase 2 when

Wound healed^[1] (yes/no check)
Surgeon clears loading in the boot^[1]

Phase 2 · Boot and early motion

wk 2–6Create HEP for Phase 2 →

Allowed

Active plantar flexion, inversion and eversion out of the boot, seated^{[6, 5]}
Stationary bike in the boot, once the wound has healed^{[4, 1]}
Band plantar flexion from wk 4^[5]

Avoid

Dorsiflexion past neutral (until wk 8)
Calf stretching (until wk 12)
Walking without the boot (until wk 6)
Driving until the surgeon has cleared it (no source gives a week)

Exercises

Ankle Pumps10 × 10 s, 3 times a day

Isometric Ankle Inversion10 × 10 s, 3 times a day

Isometric Ankle Eversion10 × 10 s, 3 times a day

Stationary Bikein the boot, 10–20 min (sets/reps: our default)

Resisted Ankle Plantarflexion (Band)2–3 × 10–15 (sets/reps: our default) · from wk 4

Advance to Phase 3 when

Full weight bearing in the boot without pain^[1] (yes/no check)
Active dorsiflexion to neutral, knee bent^[1] (yes/no check)

Phase 3 · Out of the boot

wk 6–12Create HEP for Phase 3 →

Allowed

Seated heel raises, knee bent, then double-leg standing heel raises^[1]
Squats, step-ups and lunges in the available range^[1]
Balance work^[5]

Avoid

Dorsiflexion past neutral (until wk 8)
Calf stretching (until wk 12)
Stairs and other high eccentric loads until there is a strength base^[1]
Running and jumping until wk 12^[1]

Exercises

Seated Calf Raise2–3 × 10–15 (sets/reps: our default)

Standing Calf Raise2–3 × 10–15 (sets/reps: our default) · from wk 8

Resisted Ankle Inversion (Band)2–3 × 10–15 (sets/reps: our default)

Resisted Ankle Eversion (Band)2–3 × 10–15 (sets/reps: our default)

Leg Press2–3 × 10–15 (sets/reps: our default)

Standing Mini Squat2–3 × 10–15 (sets/reps: our default)

Step Up2–3 × 10–15 (sets/reps: our default)

Single Leg Balance3 × 30 s (sets/reps: our default)

Advance to Phase 4 when

Pain-free full-range double-leg heel raise^[1] (yes/no check) test: 2-leg heel raise
Normal gait in shoes^[1] (yes/no check)

Phase 4 · Single leg, running, jumping

wk 12–24Create HEP for Phase 4 →

Allowed

Eccentric calf work from wk 12^[5]
Gentle standing calf stretching from wk 12^[1]
Running progression once the running criteria are met, and plyometrics from wk 16, low-level drills first^{[1, 5]}

Avoid

Running until the running criteria are met^[1]

Exercises

Single Leg Heel Raise2–3 × 10–15 (sets/reps: our default)

Eccentric Slow Lowers (Floor)2–3 × 10–15 (sets/reps: our default)

Lateral Step Up2–3 × 10–15 (sets/reps: our default)

Knee-to-Wall Dorsiflexion Mobilization3 × 30 s, gentle (sets/reps: our default)

Standing Calf Stretch (Gastrocnemius)3 × 30 s, gentle (sets/reps: our default)

Soleus Stretch (Bent-Knee)3 × 30 s, gentle (sets/reps: our default)

Walking Programbuild to 30 min (sets/reps: our default)

Advance to Phase 5 when

Running and plyometric progressions completed^[1] (yes/no check)

Phase 5 · Return to sport

wk 24–52Create HEP for Phase 5 →

Allowed

Heavier and eccentric calf loading past neutral^[1]

Avoid

Sport until the return-to-sport criteria are met^[1]

Exercises

Eccentric Heel Drop (Straight Knee)3 × 15 (sets/reps: our default)

Single Leg Heel Raise2–3 × 10–15 (sets/reps: our default)

Discharge from PT when

At least 6 months since surgery^{[13, 1]}
Heel-rise test ≥ 90% of the other leg, for repetitions and total work^[1] test: Heel-rise test
Plantar flexion strength ≥ 90% of the other leg^[1] test: PF strength
Single hop for distance ≥ 90% of the other leg^[1] test: Single hop
Surgeon clearance^[1]

Return to sport when

At least 6 months since surgery^{[13, 1]}
Heel-rise test ≥ 90% of the other leg, for repetitions and total work^[1] test: Heel-rise test
Plantar flexion strength ≥ 90% of the other leg^[1] test: PF strength
Single hop for distance ≥ 90% of the other leg^[1] test: Single hop
Surgeon clearance^[1]

Phase	Allowed	Avoid	Exercises	Advance / discharge when
Phase 1 · Protect the repair wk 0–2	Toe, knee and hip exercises in the splint^{[5, 1]} Submaximal calf isometrics inside the splint or boot, pain-free^[1]	Dorsiflexion past neutral (until wk 8) Calf stretching (until wk 12) Walking without the boot (until wk 6) Driving until the surgeon has cleared it (no source gives a week) Pool or soaking (one compared protocol) until the wound has healed^[26]	Quad Set 2–3 × 10–15 (sets/reps: our default) Active Straight Leg Raise with Quad Set 2–3 × 10–15 (sets/reps: our default) Hip Abduction (Side-Lying) 2–3 × 10–15 (sets/reps: our default) Prone Hip Extension 2–3 × 10–15 (sets/reps: our default) Toe Yoga 2–3 × 10–15 (sets/reps: our default) Isometric Ankle Plantarflexion submaximal, pain-free	Wound healed^[1] (yes/no check) Surgeon clears loading in the boot^[1]
Phase 2 · Boot and early motion wk 2–6	Active plantar flexion, inversion and eversion out of the boot, seated^{[6, 5]} Stationary bike in the boot, once the wound has healed^{[4, 1]} Band plantar flexion from wk 4^[5]	Dorsiflexion past neutral (until wk 8) Calf stretching (until wk 12) Walking without the boot (until wk 6) Driving until the surgeon has cleared it (no source gives a week)	Ankle Pumps 10 × 10 s, 3 times a day Isometric Ankle Inversion 10 × 10 s, 3 times a day Isometric Ankle Eversion 10 × 10 s, 3 times a day Stationary Bike in the boot, 10–20 min (sets/reps: our default) Resisted Ankle Plantarflexion (Band) 2–3 × 10–15 (sets/reps: our default) · from wk 4	Full weight bearing in the boot without pain^[1] (yes/no check) Active dorsiflexion to neutral, knee bent^[1] (yes/no check)
Phase 3 · Out of the boot wk 6–12	Seated heel raises, knee bent, then double-leg standing heel raises^[1] Squats, step-ups and lunges in the available range^[1] Balance work^[5]	Dorsiflexion past neutral (until wk 8) Calf stretching (until wk 12) Stairs and other high eccentric loads until there is a strength base^[1] Running and jumping until wk 12^[1]	Seated Calf Raise 2–3 × 10–15 (sets/reps: our default) Standing Calf Raise 2–3 × 10–15 (sets/reps: our default) · from wk 8 Resisted Ankle Inversion (Band) 2–3 × 10–15 (sets/reps: our default) Resisted Ankle Eversion (Band) 2–3 × 10–15 (sets/reps: our default) Leg Press 2–3 × 10–15 (sets/reps: our default) Standing Mini Squat 2–3 × 10–15 (sets/reps: our default) Step Up 2–3 × 10–15 (sets/reps: our default) Single Leg Balance 3 × 30 s (sets/reps: our default)	Pain-free full-range double-leg heel raise^[1] (yes/no check) test: 2-leg heel raise Normal gait in shoes^[1] (yes/no check)
Phase 4 · Single leg, running, jumping wk 12–24	Eccentric calf work from wk 12^[5] Gentle standing calf stretching from wk 12^[1] Running progression once the running criteria are met, and plyometrics from wk 16, low-level drills first^{[1, 5]}	Running until the running criteria are met^[1]	Single Leg Heel Raise 2–3 × 10–15 (sets/reps: our default) Eccentric Slow Lowers (Floor) 2–3 × 10–15 (sets/reps: our default) Lateral Step Up 2–3 × 10–15 (sets/reps: our default) Knee-to-Wall Dorsiflexion Mobilization 3 × 30 s, gentle (sets/reps: our default) Standing Calf Stretch (Gastrocnemius) 3 × 30 s, gentle (sets/reps: our default) Soleus Stretch (Bent-Knee) 3 × 30 s, gentle (sets/reps: our default) Walking Program build to 30 min (sets/reps: our default)	Running and plyometric progressions completed^[1] (yes/no check)
Phase 5 · Return to sport wk 24–52	Heavier and eccentric calf loading past neutral^[1]	Sport until the return-to-sport criteria are met^[1]	Eccentric Heel Drop (Straight Knee) 3 × 15 (sets/reps: our default) Single Leg Heel Raise 2–3 × 10–15 (sets/reps: our default)	Discharge from PT: At least 6 months since surgery^{[13, 1]} Heel-rise test ≥ 90% of the other leg, for repetitions and total work^[1] test: Heel-rise test Plantar flexion strength ≥ 90% of the other leg^[1] test: PF strength Single hop for distance ≥ 90% of the other leg^[1] test: Single hop Surgeon clearance^[1] Return to sport: At least 6 months since surgery^{[13, 1]} Heel-rise test ≥ 90% of the other leg, for repetitions and total work^[1] test: Heel-rise test Plantar flexion strength ≥ 90% of the other leg^[1] test: PF strength Single hop for distance ≥ 90% of the other leg^[1] test: Single hop Surgeon clearance^[1]

How published protocols differ

Published protocols agree on starting in plantar flexion and stepping down to a flat boot, and differ most on when weight bearing starts, how long the boot stays on, how far dorsiflexion and calf stretching are held back, and the running and return-to-sport gates. Sanford's 2026 edition is built on one of our sources^[1], so where the two agree they count as one source, not two.

Decision points across published Achilles repair protocols (facts in our words, each linked to its source).
Decision point	This protocol	Sanford Health^[24]source ↗ · rev. Apr 2026 · checked Oct 2026	Mass General Brigham^[25]source ↗ · rev. Mar 2026 · checked Oct 2026	UW Health^[26]source ↗ · updated Sep 2019 · checked Oct 2026	Lahey Hospital & Medical Center^[27]source ↗ · Dec 2019 · checked Oct 2026
Boot and heel wedges	Splint wk 0–2; boot with 3 wedges from wk 2, one out every 1–2 weeks; shoe with a heel lift typically wk 6–8	Splint, then boot; wedge lowered by height every 1–2 weeks; shoe with a small wedge at wk 8, none at wk 10	Splint wk 0–1, boot from wk 2; 3 wedges out at wk 6, 8 and 10; sneaker with a 1 cm lift at wk 12–14	Boot or splint in plantar flexion wk 0–2; one or two ¼-inch lifts, out by wk 8	Splint wk 0–2, cast wk 2–6, boot from wk 6; shoe at wk 12–16
Weight bearing	Per the surgeon wk 0–2; WBAT in the boot from wk 2; full in the boot typically wk 4	None for 2–4 weeks per the surgeon; partial, then full in the boot by wk 6	None wk 0–3; as tolerated in the boot from wk 4; full, no device, to leave wk 6–11	Touch-down with crutches wk 0–2 (one surgeon: none), then as tolerated in the boot	None until about wk 6; full weight in wk 8–12
Dorsiflexion and calf stretching	No dorsiflexion past neutral to wk 8; no calf stretching to wk 12	Neutral for 6 weeks, passive at neutral to 3 months; light stretching to neutral from wk 2–6	5° short of neutral to wk 4; no calf stretching through wk 14; standing stretches at 6 months	Active dorsiflexion to neutral as an early goal; one surgeon: none past neutral for 3 months; calf stretching at about wk 12	Cast to wk 6; no passive dorsiflexion wk 8–12; no angle given; stretching wk 12–16
Running and return to sport	Running from wk 12 once 10 single-leg heel raises and squat control are met; sport from 6 mo at ≥ 90% heel-rise, strength and hop	Anti-gravity treadmill from wk 14 behind strength and heel-raise criteria; sport from 24 wk at 90% strength	Anti-gravity treadmill at months 3.5–6 once two-leg plyometrics go well; sport at 6+ months: single-leg tests ≥ 95%, ATRS over 90	No running date or criteria; return-to-sport tests named without thresholds	Jogging and impact sports with surgeon clearance only

For percutaneous repair, one compared health system publishes a slower guideline: no weight bearing to wk 4, the boot to wk 9–10, no dorsiflexion past neutral before 3 months, and under 15% side-to-side difference on strength and hop tests before sport^[28].

Different numbers from the surgeon?

Match the surgeon's protocol →

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Each value is a fact in our words, linked to its source with the version and the date we checked it. Not affiliated with or endorsed by the institutions listed.

Tests and measures

Heel-rise results are limb symmetry: the operated leg as a share of the other. Repetitions recover sooner than heel height and total work, so a full count can hide a weak end range^[3].

Tests and measures, Surgical repair
Test	Phase 1 exit	Phase 3 exit	Discharge · return to sport	Return to running
Single hop for distance			≥ 90%
Single-leg hop distance, as limb symmetry. Hop battery: 2 practice and 2 measured trials per leg^{[22, 23]}
Single-leg heel-rise test to fatigue			≥ 90%
Calf endurance and power: repetitions, heel height and total work, as limb symmetry. Single-leg heel rises to fatigue at 30 a minute, knee straight, often on a 10° slant board; operated leg as a share of the other^{[1, 3, 5, 18]}
Double-leg heel raise, full range		full-range 2-leg heel raise
A pain-free double-leg heel raise to full height. Standing on both legs, heels rise to full height with even weight on both sides^[1]
Single-leg heel raises through full range				10 full-range 1-leg heel raises
How many full-height single-leg heel raises the operated leg can do. Count of full-range raises on the operated leg; the pass mark is a count^{[1, 7]}
Plantar flexion strength on a dynamometer			≥ 90%
Isometric plantar flexion strength, as limb symmetry. Seated, isometric, on a dynamometer; operated leg as a share of the other^{[1, 5]}
Single-leg squat control				good 1-leg squat control
Control and mechanics through a single-leg squat. Observed single-leg squat on the operated leg^[1]
Calf circumference	Tracked, not a gate
Calf muscle size: the shortfall against the other side. Tape measure 15 cm below the knee joint line, both legs^[6]
Achilles tendon Total Rupture Score (ATRS)	Tracked, not a gate
Self-reported symptoms and function after an Achilles rupture. Scored 0 to 100; acceptable symptom state 75 at 12–27 months^{[15, 16]} Copyrighted instrument: named and linked, never reproduced. About the instrument ↗

Each pass mark is this protocol's clinical call, cited to its sources. Questionnaires are named and linked, never reproduced.

References and basis

Reviewed by a licensed physical therapist (HEP Drop staff)Page reviewed Oct 2026Literature checked through Oct 2026Protocols checked Oct 2026Version 2026.10 · changelogHow we write protocols

What backs each recommendation

Our summary, in our own words, of what each source supports. "Strongest evidence" is the study design as published; a review that pools only cadaver studies is listed as a lab study. "Limited evidence" means no randomized trial or systematic review of patient studies is among that row's sources; we do not grade our own recommendations.

What backs each recommendation, Surgical repair
Recommendation	This protocol	Based on	Strongest evidence	What's uncertain
Phase 1 · Protect the repair · wk 0–2
Weight bearing	per the surgeon wk 0–2; WBAT in the boot from wk 2; full in the boot typically wk 4	[2] Valkering 2017 [3] Aufwerber 2020a [1] Marrone 2024	RCT	The trials load fully by 2 weeks with no rise in rerupture^[9]; the compared protocols start later, and only 39% of Dutch surgeons allow weight bearing within 2 weeks^[21].
Boot and wedges	3 wedges from wk 2, one out every 1–2 weeks; shoe with a heel lift typically wk 6–8	[2] Valkering 2017 [5] Maffulli 2022 [3] Aufwerber 2020a	RCT	Wedge count, removal pace and boot time differ between sources; after percutaneous repair one non-randomized cohort did better with a 12-week boot^[5].
Phase 2 · Boot and early motion · wk 2–6
Dorsiflexion limit	none past neutral to wk 8	[1] Marrone 2024 [5] Maffulli 2022	Cohort study Limited evidence	The commentary gives 4–6, 8, 10 and 12 weeks in different places^[1].
Calf stretching	none to wk 12	[1] Marrone 2024 [17] Maquirriain 2011	Narrative review Limited evidence
Phase 4 · Single leg, running, jumping · wk 12–24
Running	not before wk 12, once the running criteria are met	[1] Marrone 2024	Narrative review Limited evidence	Only one open source gives running criteria^[1].

Where evidence is limited

Dorsiflexion limit: The commentary gives 4–6, 8, 10 and 12 weeks in different places^[1].
Running: Only one open source gives running criteria^[1].

Bibliography

1.Marrone W, Andrews R, Reynolds A, et al. Rehabilitation and Return to Sports after Achilles Tendon Repair. Int J Sports Phys Ther. 2024;19(9):1152–1165.
Narrative review (clinical commentary with a 5-phase table, restrictions and return-to-sport tests) · PMC11379499 (free full text) · doi:10.26603/001c.122643 · CC BY-NC 4.0 · cited, not reproduced · Used for: Weight bearing · Dorsiflexion limit · Calf stretching · Running
2.Valkering KP, Aufwerber S, Ranuccio F, et al. Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(6):1807–1816.
RCT (n = 56; immediate weight bearing in a hinged orthosis vs non-weight-bearing cast after repair) · PMC5487693 (free full text) · doi:10.1007/s00167-016-4270-3 · CC BY 4.0 · cited · Used for: Weight bearing · Boot and wedges
3.Aufwerber S, Heijne A, Edman G, et al. Does Early Functional Mobilization Affect Long-Term Outcomes After an Achilles Tendon Rupture? A Randomized Clinical Trial. Orthop J Sports Med. 2020;8(3):2325967120906522.
RCT (n = 135; early functional mobilization vs cast then orthosis, ATRS and heel-rise to 12 months) · PMC7076581 (free full text) · doi:10.1177/2325967120906522 · CC BY-NC-ND 4.0 · cited, not reproduced · Used for: Weight bearing · Boot and wedges
4.Aufwerber S, Heijne A, Edman G, et al. Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2020;28(1):312–319.
RCT (n = 150; DVT on ultrasound screening with early mobilization vs cast after repair, loading and step counts) · PMC6971132 (free full text) · doi:10.1007/s00167-019-05767-x · CC BY 4.0 · cited
5.Maffulli N, Gougoulias N, Maffulli GD, et al. Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture. Foot Ankle Int. 2022;43(2):244–252.
Cohort study (n = 60, prospective comparative (not randomized); boot to 8 vs 12 weeks after percutaneous repair, full protocol table) · PMC8841642 (free full text) · doi:10.1177/10711007211038594 · CC BY 4.0 · cited · Used for: Boot and wedges · Dorsiflexion limit
6.Carmont MR, Grävare Silbernagel K, Brorsson A, et al. The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015;2(2):49–55.
Cohort study (n = 26; resting angle, ATRS and heel-rise to 12 months after minimally invasive repair) · PMC5730640 (free full text) · doi:10.1016/j.asmart.2014.12.002 · CC BY-NC-ND 4.0 · cited, not reproduced
7.Christensen M, Silbernagel KG, Zellers JA, et al. Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture. Pilot Feasibility Stud. 2024;10(1):66.
Cohort study (n = 16, single-arm feasibility; early resistance exercises in the boot, non-operative) · PMC11034137 (free full text) · doi:10.1186/s40814-024-01494-4 · CC BY 4.0 · cited
8.Wang R, Huang L, Jiang S, et al. Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials. Int J Surg. 2024;110(6):3888–3899.
Systematic review (43 RCTs, n = 2,553; rerupture by rehab type and motion timing after repair) · PMC11175757 (free full text) · doi:10.1097/js9.0000000000001305 · CC BY-ND 4.0 · cited, not reproduced
9.Massen FK, Shoap S, Vosseller JT, et al. Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. EFORT Open Rev. 2022;7(10):680–691.
Systematic review (20 RCTs, n = 1,007; weight bearing and mobilization groups after repair) · PMC9619394 (free full text) · doi:10.1530/eor-22-0072 · CC BY-NC 4.0 · cited, not reproduced
10.Zhao JG, Meng XH, Liu L, et al. Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses. Sci Rep. 2017;7:39871.
Systematic review (review of 6 overlapping meta-analyses, early functional rehab vs cast after repair) · PMC5215510 (free full text) · doi:10.1038/srep39871 · CC BY 4.0 · cited
11.Wei Z, Cui Z, Cao Y, et al. Comparative analysis of different mobility aids in the early accelerated rehabilitation phase following acute achilles tendon repair surgery: a prospective cohort study. J Orthop Surg Res. 2026;21(1):279.
Cohort study (n = 198; wheelchair, knee scooter, crutches or leg-support walker in weeks 3-6; falls and milestones) · PMC13123103 (free full text) · doi:10.1186/s13018-026-06881-6 · CC BY 4.0 · cited
12.Guerot M, Khiami F, Valentin E, et al. Return to Sport and Return to Self-Reported Preinjury Level After Surgical Repair of Acute Achilles Tendon Rupture: A 2-Year Prospective Cohort Analysis. J Clin Med. 2026;15(17):6512.
Cohort study (n = 65 (sport analysis); return to sport and pre-injury level over 2 years, with its boot protocol) · PMC13566404 (free full text) · doi:10.3390/jcm15176512 · CC BY 4.0 · cited
13.Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med. 2016;50(21):1325–1332.
Systematic review (108 studies, n = 6,506; return to play rate, timing and how it was measured) · PMC5136353 (free full text) · doi:10.1136/bjsports-2016-096106 · © publisher · cited only
14.Cofano E, Colace S, Piro F, et al. Successful functional outcomes and return to sport rate can be achieved after surgery for acute Achilles tendon rupture: A systematic review. J Exp Orthop. 2025;12(4):e70469.
Systematic review (9 studies, n = 748; return to sport after open and minimally invasive repair) · PMC12560252 (free full text) · doi:10.1002/jeo2.70469 · CC BY 4.0 · cited
15.Larsson E, Brandt Knutsson S, Brorsson A, et al. Establishment of the Patient Acceptable Symptom State (PASS) for the Achilles Tendon Total Rupture Score in a Swedish Population. Orthop J Sports Med. 2024;12(7):23259671241253280.
Cross-sectional study (n = 316; ATRS acceptable symptom state at 12-27 months) · PMC11273557 (free full text) · doi:10.1177/23259671241253280 · CC BY 4.0 · cited
16.Dams OC, Reininga IHF, Zwerver J, et al. The Achilles tendon Total Rupture Score is a responsive primary outcome measure: an evaluation of the Dutch version including minimally important change. Knee Surg Sports Traumatol Arthrosc. 2020;28(10):3330–3338.
Cohort study (n = 47; ATRS responsiveness and minimally important change, 3 to 6 months) · PMC7511458 (free full text) · doi:10.1007/s00167-020-05924-7 · CC BY 4.0 · cited
17.Maquirriain J. Achilles tendon rupture: avoiding tendon lengthening during surgical repair and rehabilitation. Yale J Biol Med. 2011;84(3):289–300.
Narrative review (tendon lengthening, heel lifts, early motion and repair strength) · PMC3178860 (free full text) · CC BY-NC 4.0 · cited, not reproduced · Used for: Calf stretching
18.Zellers JA, Carmont MR, Silbernagel KG. Achilles Tendon Resting Angle Relates to Tendon Length and Function. Foot Ankle Int. 2018;39(3):343–348.
Cross-sectional study (n = 42; resting angle vs ultrasound tendon length and heel-rise work) · PMC6047896 (free full text) · doi:10.1177/1071100717742372 · © publisher · cited only
19.Costa ML, Achten J, Marian IR, et al. Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020;395(10222):441–448.
RCT (UKSTAR, n = 540 at 39 hospitals; cast vs functional brace with wedges, non-operative) · PMC7016510 (free full text) · doi:10.1016/s0140-6736(19)32942-3 · CC BY 4.0 · cited
20.Zellers JA, Christensen M, Kjær IL, et al. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med. 2019;7(11):2325967119884071.
Systematic review (174 studies, n = 9,098; what early functional rehab contains and when it starts) · PMC6878623 (free full text) · doi:10.1177/2325967119884071 · CC BY-NC-ND 4.0 · cited, not reproduced
21.Dams OC, van den Akker-Scheek I, Diercks RL, et al. Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines. Knee Surg Sports Traumatol Arthrosc. 2019;27(9):2754–2764.
Protocol survey (91 Dutch orthopaedic and trauma surgeons, diagnosis to return to sport) · PMC6706364 (free full text) · doi:10.1007/s00167-018-5049-5 · CC BY 4.0 · cited
22.Adams D, Logerstedt DS, Hunter-Giordano A, et al. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601–614.
Narrative review (Delaware criterion-based progression with milestones (clinical commentary)) · PMC3576892 (free full text) · doi:10.2519/jospt.2012.3871 · © publisher · cited only
23.Grindem H, Snyder-Mackler L, Moksnes H, et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804–808.
Cohort study (n = 106, Delaware-Oslo, return-to-sport timing, criteria and reinjury) · PMC4912389 (free full text) · doi:10.1136/bjsports-2016-096031 · © publisher · cited only

Published protocols compared (24–28)

Compared, not endorsed. Not affiliated with or endorsed by the institutions listed. Versions and checked dates match the How published protocols differ table.

24.Sanford Health. Achilles tendon repair rehabilitation post-operative guideline [PDF]. Revised Apr 2026.
Published protocol · Protocol PDF (www.sanfordhealth.org/-/media/org/files/medical-professionals/resources-and-education/achilles-tendon-repair.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
25.Mass General Brigham. Rehabilitation protocol for Achilles rupture repair [PDF]. Revised Mar 2026.
Published protocol · Protocol PDF (www.massgeneralbrigham.org/content/dam/unified-xwalk/pdf/patient-education/english/pt-guidelines-for-achilles-rupture-repair.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
26.UW Health. Rehabilitation guidelines for Achilles tendon repair [PDF]. Version updated Sep 2019.
Published protocol · Guideline PDF (bynder.uwhealth.org/m/583f38cdd2a085b1/original/Rehab-Guideline-Achilles-Tendon-Repair.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ
27.Lahey Hospital & Medical Center. Rehabilitation protocol: Achilles tendon repair protocol [PDF]. Version Dec 2019.
Published protocol · Protocol PDF (www.lahey.org/-/media/files/lhmc/orthopedics/foot/lhmc-achilles-tendon-rupture-repair-protocol.pdf) · checked Oct 2026 · Compared, not endorsed · Used for: How protocols differ · Key milestones: published ranges
28.UW Health. Rehabilitation guidelines for PARS Achilles tendon repair [PDF]. Version no date printed.
Published protocol · Guideline PDF (bynder.uwhealth.org/m/314ea22bcadd236b/original/Rehabilitation-Guideline-PARS-Achilles-Tendon-Repair.pdf) · checked Oct 2026 · Compared, not endorsed

Licenses and adaptation. All are licensed under CC BY 4.0 (creativecommons.org/licenses/by/4.0). No warranties are given by the original authors.

[3] Aufwerber 2020a, [6] Carmont 2015 and [20] Zellers 2019 are CC BY-NC-ND 4.0, [1] Marrone 2024, [9] Massen 2022 and [17] Maquirriain 2011 are CC BY-NC 4.0 and [8] Wang 2024 is CC BY-ND 4.0: we summarize their findings in our own words and reproduce no text, tables or figures. [13] Zellers 2016, [18] Zellers 2018, [22] Adams 2012, [23] Grindem 2016, [26] UW Health and [28] UW Health (PARS repair) are not openly licensed (all rights reserved): we state their findings and numbers in our own words and reproduce no text, tables or figures.

Published protocols [24]–[28] are compared, not endorsed. Not affiliated with or endorsed by the institutions listed.

Changelog

Version	Date	What changed	Type	Recommendations affected	Reviewed by	Sources
2026.10	Oct 2026	First published version	—	All	Licensed PT	23

Cite this protocolHEP Drop. Achilles tendon repair rehabilitation protocol. Version 2026.10. Reviewed Oct 2026. hepdrop.com/p/achilles

For specific clinical claims, cite the original sources above.

Achilles Tendon Repair Protocol · Surgical repair · Version 2026.10 · hepdrop.com/p/achilles · The operating surgeon's protocol takes precedence.

Milestone	This protocol	Range in published protocols
Out of the boot	wk 6	wk 6–16^{[24, 25, 26, 27]}, two of four by wk 8
Full weight bearing	wk 4	wk 6–12^{[24, 25, 27]}, three give a week: wk 6, wk 6–11, wk 8–12
Running	wk 12	wk 14 to 6 mo^{[24, 25, 27]}, three give a week: wk 14, 3.5 mo, 4+ mo
Return to sport	from 6 mo	24 wk to 6+ mo^{[24, 25]}, two give a time: 24 wk and 6+ mo

Test	Phase 3 exit	Discharge · return to sport	Return to running
Single hop^{[22, 23]}		≥ 90%
Heel-rise test, PF strength^{[1, 3, 5, 18]}		≥ 90%
2-leg heel raise^[1]	full-range 2-leg heel raise
1-leg heel raises^{[1, 7]}			10 full-range 1-leg heel raises
1-leg squat^[1]			good 1-leg squat control

Achilles Tendon Repair Protocol

Timeline

Phase

Weight bearing

Boot

Motion

Strength

Care

Restrictions

Milestones

First 12 weeks

Phase

Weight bearing

Boot

Motion

Restrictions

Milestones

Phase 1 · Protect the repair

Key milestones by week

All phases

Phase 1 · Protect the repair

Phase 2 · Boot and early motion

Phase 3 · Out of the boot

Phase 4 · Single leg, running, jumping

Phase 5 · Return to sport

How published protocols differ

Tests and measures

References and basis

What backs each recommendation

Bibliography

Published protocols compared (24–28)

Changelog

Exercises by phase * sets and reps are our default.

Phase 1 · Protect the repair wk 0–2

Phase 2 · Boot and early motion wk 2–6

Phase 3 · Out of the boot wk 6–12

Phase 4 · Single leg, running, jumping wk 12–24

Phase 5 · Return to sport wk 24–52

Return to sport when

Tests and pass marks

Key milestones vs published protocols

Sources