Life After Achilles Surgery: What to Expect in Physical Therapy
- Mark Jamantoc
- Aug 31
- 3 min read
An Achilles tendon rupture often happens suddenly—and it can feel like life comes to a halt. Patients are sometimes surprised by how it occurs and how long recovery takes.
Scenario 1: The Weekend AthleteYou’re playing a game of tennis on a Saturday morning. You push off to step forward to hit the tennis ball and suddenly feel like someone kicked you in the back of the ankle. You look around—but no one is there. Walking feels impossible, and the sharp pain leaves you worried something serious just happened.
Scenario 2: The Everyday Active Adult. You’re out for a morning jog, or maybe just stepping off a curb, when you feel a sudden “pop” in your lower leg. It doesn’t take a high-level sport for the Achilles tendon to give way. Even active adults in their 30s, 40s, and 50s can experience this injury during daily life.
In all these cases, the next step is often surgical repair followed by a structured rehab plan. Many patients ask: “What should I expect in physical therapy week by week?” While every recovery is unique, we can outline the typical milestones supported by the latest evidence and clinical practice guidelines.
The First Weeks: Protection and Healing
Weeks 0–2
You’ll usually be in a splint or boot, non-weight bearing with crutches.
The main focus is on wound care, swelling control, and gentle motion (but only up to neutral).
Your PT may also give you exercises for your hips, knees, and core to keep you moving.
Early Weight Bearing Phase
Weeks 3–4
Transition to protected weight bearing in a boot with heel lifts.
Begin light ankle range of motion, but do not push past neutral.
PT sessions often focus on safe walking patterns and gentle activation of surrounding muscles.
Weeks 5–6
Start to remove heel wedges gradually.
Walking in the boot becomes easier as your stride improves.
Strength work often includes seated heel raises and balance drills (still in the boot).
Transition to Shoes
Weeks 7–8
The boot begins to come off. Many patients start spending time in supportive shoes (sometimes with small heel lifts).
Gentle strengthening continues, with more emphasis on calf raises and weight-bearing balance.
Weeks 9–12
Focus shifts to double-leg then single-leg heel raises.
Low-impact cardio such as biking or elliptical is added.
If milestones are met (like normal gait and sufficient heel-raise strength), some patients begin walk–jog intervalsaround 12 weeks.
Building Strength and Power
Weeks 13–16
Plyometrics (small hops, rebounding drills) and agility training begin under PT supervision.
Running volume gradually increases, but only if strength and control are adequate.
Months 6–9+
Return to sport or higher-level activity becomes possible once testing shows:
≥90% strength and hop performance compared to the other leg
Good movement quality and confidence
This timeline can vary widely depending on sport demands and individual healing.
Key Things to Remember
Every recovery is different. Your specific timeline depends on your surgeon’s repair technique, your healing response, and your goals.
Follow criteria, not just the calendar. A certain week doesn’t automatically mean you’re ready for the next phase. PTs use strength tests, gait analysis, and functional milestones to decide when to progress.
Don’t rush stretching. Over-stretching the calf too early can cause tendon elongation and long-term weakness.
Final Thoughts
Rehab after Achilles surgery takes patience, consistency, and guidance from your physical therapist. With evidence-based progressions and careful monitoring, you’ll safely return to the activities you love.
References (for patient education)
Massachusetts General Brigham Sports Medicine. Rehabilitation Protocol for Achilles Rupture Repair. 2025.
Ohio State University Wexner Medical Center. Achilles Tendon Repair Clinical Practice Guideline. 2022.
Marrone W, et al. Rehabilitation and Return to Sports after Achilles Tendon Repair. Int J Sports Phys Ther. 2024.
McCormack R, Bovard J. Early functional rehab vs cast immobilization: systematic review & meta-analysis. Br J Sports Med. 2015.
Eliasson P, et al. Achilles tendon elongation up to 6 months post-repair. Am J Sports Med. 2018.
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