Achilles Rupture Recovery Timeline
Bam! You have ruptured your Achilles. You were playing sports one minute and in the ER the next. A cast or a boot is likely your newest accessory and you were told you can’t do much for the next little while.
Achilles ruptures are one of the toughest sports injuries you can sustain. Welcome to the club! It’s a special one. Aaron Rogers, David Beckham, The Rock, Breanna Stewart, Kevin Durant, Brad Pitt… it’s a long list!
Do you wonder when you can walk, drive and play sports again? We’ve got your back. In this blog we will discuss the Achilles rupture recovery timeline.
Do you wonder when you can walk, drive and play sports again? We’ve got your back. In this blog we will discuss the Achilles rupture recovery timeline.
How does an Achilles rupture happen?
The Achilles tendon connects the calf muscle to the heel bone. There are many reasons why you may rupture your tendon:
Sudden, forceful contraction of the calf muscle
Pivoting, twisting, changing directions suddenly
Landing from a height in a position where the calf and Achilles are overstretched
Underlying tendonitis, injury, or age-related changes (still often coupled with the movements above)
Direct trauma or impact
And probably the most important: you were not ready for the amount of activity (volume, speed, duration) you were trying to do. We all love to play basketball with kids half our age, but our poor Achilles can’t always keep up without proper training.
The first steps
There are two treatment options for an Achilles rupture: non-surgical and surgical treatment. It may feel like an overwhelming choice, however, it is important to know that you can do really well with both options.
The most frustrating part of the injury is the existence of a million different protocols, and sadly, they are often based on outdated principles and research. Based on your surgeon’s protocol, the timeline -especially the first 8-12 weeks- may look drastically different. And it is OK. Frustrating, but OK.
We see it over and over at our clinic-even if your surgeon starts you on a very conservative protocol and you don’t start weight-bearing until 8-12 weeks (!) post-injury, you can catch up. It just changes the expectations about the recovery timeline.
The phases of rehab are named differently in each protocol, but they generally follow a similar Achilles rupture recovery timeline:
Phase 1 (approx. 0-8 weeks): usually a mix of non-weight bearing followed by a gradual increase to full weight bearing in a walking boot. Your toe is initially pointed down to allow the Achilles tendon to heal, and it is gradually brought back to neutral to allow the Achilles tendon to function in its normal range. We often include seated calf raises and resistance band strengthening at this phase.
Phase 2 (approx 8-12 weeks): The goal is weaning out of the boot and learning to walk again with a normal pattern. You can expect that your walking speed and endurance will be limited until 4-5 months post-rupture. This is when the bulk of calf strengthening in standing is initiated.
Phase 3 (12-26 weeks): The first part focuses on building up calf strength throughout the entire range so you can start a return to running program and basic agility and plyometric drills towards the second part of this phase. It is also important to build back general lower body strength and cardio during this time.
Phase 4 (26+ weeks): Return to sport/advanced rehab. Depending on the sport and the demands of the specific movements on the tendon, this may take another 3-6+ months. It’s important to continue building single-leg calf strength and progress plyometric and agility drills to work on the “springiness” of the Achilles tendon.
Factors influencing healing and successful return to activities:
Age (you heal better in your 20’s and 30’s)
Consistency with rehab and exercise program
General health (no smoking, limited alcohol intake)
Stress level and enough sleep
General fitness level pre-injury
How long after my Achilles surgery can I walk?
This will depend on your surgeon or healthcare professional’s recommendation but the advice is basically the same for a surgical repair vs non-surgical. Sometimes you are allowed to weight-bear right away, sometimes you have to wait a few weeks (or more).
We know that the tendon heals and strengthens when you start putting weight on it, so you shouldn’t be afraid of doing so. The most important thing is weight-bearing through your heel, midfoot, and rolling gently through your toes.
The instinct is just to put your toe down and do “toe touch weight-bearing", but that will increase the load on the Achilles tendon early. Even though it’s not easy to walk with the wedges in your boot, you have to start with crutches and gradually remove them to allow for full weight-bearing in the boot.
A knee scooter can help you be more mobile and independent. It is quite useful in the first few weeks. However, by using a scooter, you are not loading the Achilles tendon which helps the tendon to heal and strengthen. You should be using it less frequently over the first 6 weeks.
The goal is to start weaning from the boot around the 8-week mark. It starts indoors with shoes on. Week by week, you are given the go-ahead to increase your walking inside and progress to outside. The majority of our patients have ditched their boot by 12 weeks, but exceptions do apply. For instance, putting the boot back on when at the airport or a concert.
When can I sleep without the boot?
Usually at the 6-8 week mark. Prior to this, you can loosen the straps a little to make it more comfortable when sleeping. Tighten it back up for walking.
Achilles night splint is a nice alternative. Some people find it too flimsy and for some reason, it’s quite overpriced in Canada.
NO plantar fascia splints, as they keep your tendon stretched out which may lead to it “healing long”.
Return to sports:
This is not a complete list and it will alter case-by-case. Make sure to check with your healthcare professional before starting any new activities. A surgeon giving you a green light after examining you for 1 minute and asking no questions may not be the best form of evaluation. If you had surgery and are young, you may be able to return to certain activities sooner. This is a rough outline for when most of our patients return to activities. If you don’t feel ready, it is 100% a-okay.
The Bottom Line
Consistency, hard work, and having a good physiotherapist pays off. If you put in the work, you will see results. Stay patient. You got this.
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