Achilles Tendon Repair Recovery in NYC – Dr. Nicholas Wessling’s Post-Op Timeline & Rehab Guide

By Nicholas A. Wessling, MDOrthopedic Surgeon – Foot & Ankle / Sports MedicineNY Orthopedics | New York City

Understanding the Injury

The Achilles tendon is the largest and strongest tendon in the human body — connecting your calf muscles (gastrocnemius and soleus) to your heel bone. Despite its size, it’s also one of the most frequently injured tendons, especially in active adults.

A rupture often happens during an explosive movement, like pushing off or jumping, and many patients describe a sudden “pop” or the feeling of being kicked in the back of the leg. For most healthy and athletic individuals, surgical repair provides the best chance to restore full strength, stability, and performance.

Phase 1: Immediate Post-Operative (Weeks 0–2)

After surgery, the priority is to protect the repair and control swelling.

What to Expect:

• Leg immobilized in a splint or cast with the foot pointed downward (plantarflexed)

• Non-weight bearing with crutches or a knee scooter

• Strict elevation and icing to reduce swelling

At your first follow-up (around 10–14 days post-op):

• Sutures are removed

• Transition to a CAM boot with heel lifts

• Begin weight-bearing as tolerated in the boot

• You may start gentle active dorsiflexion (lifting your foot upward using your own muscles), but no forced stretching or passive dorsiflexion past neutral

Phase 2: Early Motion & Controlled Loading (Weeks 3–6)

Once the incision has healed, gradual motion is reintroduced under close supervision.

Goals:

• Prevent stiffness while maintaining tendon protection

• Begin progressive plantarflexion strengthening (with light resistance bands)

• At 4 weeks, start passive dorsiflexion to neutral (90°) — but not beyond

• Low-resistance stationary cycling may begin with the seat positioned high to limit dorsiflexion

⚠️ Avoid recumbent bikes or deep dorsiflexion stretches during this stage.

Phase 3: Boot Weaning & Functional Strength (Weeks 6–9)

During this period, you’ll gradually transition out of the boot and back to normal shoes.

Milestones:

• Week 6: Begin therapy in supportive sneakers; remove one heel lift

• Week 7–8: Continue removing heel lifts from the boot weekly until your foot reaches neutral

• Week 9: Transition to supportive shoes with heel lifts as tolerated

Therapy now focuses on calf activation, balance, and gait retraining.

Phase 4: Strengthening, Gait Training & Return to Activity (Weeks 10–16+)

By this stage, your tendon has healed enough for more active strengthening and controlled stretching.

Goals:

• Gently progress dorsiflexion past neutral

• Begin eccentric calf strengthening (slow heel-drop exercises)

• Advance resistance and endurance training (pool, elliptical, or cycling)

Gait Recovery:

• Walking typically begins to normalize around 3 months, though some patients may continue to walk with a subtle hitch or limp when fatigued.

• Gait usually fully returns to normal around 4 months.

Jogging:

• A gradual return to jogging can begin around 5–6 months, once strength and symmetry have returned and cleared by your surgeon or physical therapist.

Return to Sport:

• A full return to sport — including cutting, pivoting, and explosive movements — generally occurs around 12 months post-op, depending on sport intensity and conditioning.

Tips for a Successful Recovery

• Follow the protocol: Tendon healing is gradual; pushing too early risks re-injury.

• Commit to physical therapy: Guided rehab ensures the tendon regains proper tension and strength.

• Use heel lifts as directed: They off-load the tendon during the transition phase.

• Stay fit safely: Focus on upper-body and core conditioning while protecting the repair.

• Communicate with your care team: Report any unusual swelling, pain, or “popping” sensations promptly.

When to Contact Your Surgeon

Reach out immediately if you notice:

• Increasing pain, redness, or swelling

• Wound drainage or delayed healing

• A sudden “pop” or new weakness at the repair site

• Difficulty bearing weight or pushing off the foot after the initial recovery phase

The Takeaway

Recovering from an Achilles tendon repair is a marathon, not a sprint. With patience, structured rehabilitation, and adherence to your surgeon’s protocol, most patients return to full activity and sport with restored strength and confidence. The key is steady, safe progress — not shortcuts.

Dr. Nicholas A. Wessling | Orthopedic Surgeon – Foot & Ankle / Sports Medicine

NY Orthopedics | New York City