RESTRICTIONS: 

• NO weight bearing on operative extremity x4 weeks 
• NO dorsiflexion past neutral x8 weeks 

Phase I: Protection (Weeks 0–2)

Goals 

• Protect the repair 

• Control pain and swelling with consistent elevation 

• Maintain proximal lower extremity strength 

Immobilization 

• Posterior splint in approximately 20° plantarflexion 

Weight Bearing 

• Non-weight bearing with crutches or knee scooter 

Range of Motion 

• Active ROM of knee and hip encouraged 

Therapeutic Exercises 

• Quad sets 

• Straight leg raises 

• Core exercises 

Precautions 

• Keep splint clean and dry 

Criteria to Progress 

• Incision healed 

• Pain controlled 

• Minimal swelling 

Phase II: Early Motion (Weeks 2–6) 

Goals 

• Protect repair while initiating tendon mobility 

• Gradually return to light weight bearing 

• Reduce edema 

• Prevent stiffness 

Immobilization 

• CAM walking boot with 3 heel wedges (approximately 1 inch lift) 

Weight Bearing 

• Week 4: Partial weight bearing (progress 25% à 50%) in boot with heel wedges 

• Full weight bearing in boot around 6 to 8 weeks 

Range of Motion 

Begin gentle active ROM 

• Plantarflexion 

• Inversion/Eversion 

• Dorsiflexion only to neutral (0°) 

Avoid dorsiflexion beyond neutral until at least 8 weeks. 

Therapeutic Exercises 

• Ankle AROM 

• Gentle seated heel raises (minimal load) 

• Intrinsic foot strengthening 

• Stationary bike (boot on, minimal resistance) 

• Core and proximal hip strengthening 

Precautions 

• No resisted plantarflexion 

• No passive dorsiflexion stretching 

• Avoid barefoot walking 

Criteria to Progress 

• Full weight bearing in boot 

• Minimal swelling 

• ROM to neutral without pain 

Phase III: Motion & Early Strengthening (Weeks 6–12) 

Goals 

• Restore normal gait 

• Improve ROM 

• Improve proprioception 

Weight Bearing 

• Remove one wedge every week beginning at week 6 until all removed at 8 weeks 

• Transition from CAM boot to supportive athletic shoe with heel lift 

• Gradually discontinue heel lift over several weeks 

Range of Motion 

• Progress to full ankle ROM 

• Gentle calf stretching after 8 weeks as tolerated; may stretch beyond neutral dorsiflexion after 8 weeks 

Strengthening 

• Double-leg heel raises 

• Theraband strengthening 

• Leg press (light resistance) 

• Closed-chain strengthening 

• Step-ups 

• Mini squats 

• Balance training 

• Single-leg stance progression 

Criteria to Progress 

• Full ROM 

• Normal gait 

• Able to perform 20 double-leg heel raises without pain 

 Phase IV: Strengthening (Months 3–6) 

Goals 

• Restore calf strength 

• Improve endurance 

• Improve dynamic balance 

• Prepare for higher-level activity 

Therapeutic Exercises 

• Single-leg heel raises 

• Eccentric calf strengthening 

• Lunges 

• Step-downs 

• Single-leg balance on unstable surfaces 

• Agility ladder 

• Plyometric progression (begin around 16–20 weeks if appropriate) 

Running Progression 

Initiate light jogging around 4–5 months if: 

• Pain free 

• Full ROM 

• Near-normal calf strength 

• Able to perform ≥20 single-leg heel raises 

Phase V: Return to Sport (6–9+ Months) 

Goals 

• Restore maximal strength and power 

• Return to unrestricted activities 

• Prevent reinjury 

Exercises 

• Sprint progression 

• Cutting and pivoting drills 

• Jump training 

• Sport-specific drills 

• Single-leg hopping progression 

Return to Sport Criteria 

Patient should demonstrate: 

• Full ankle ROM 

• No pain or swelling 

• Symmetric gait 

• ≥90–95% plantarflexion strength compared with contralateral side 

• Successful completion of functional hop and balance testing 

• Surgeon clearance 

 General Precautions 

• Avoid aggressive dorsiflexion stretching during the first 8 weeks. 

• Tendon elongation is associated with persistent weakness; avoid excessive early loading. 

• Swelling may persist for several months. 

• Recovery of calf strength commonly continues for 9–12 months after surgery. 

• Progression should be based on objective function rather than time alone. 

Expected Timeline 

Milestone	Typical Time
Weight bearing begins	4 weeks
Full weight bearing in boot	6-8 weeks
Transition to shoe	8-10 weeks
Double-leg heel raises	10-12 weeks
Single-leg heel raises	12–16 weeks
Begin jogging	4–5 months
Return to recreational sports	6–9 months
Full recovery of strength	9–12 months