Achilles tendon surgery is typically performed to repair a ruptured tendon. The goal of the surgery is to reconnect the torn ends of the tendon, providing a stable environment for healing. Recovery is a lengthy process that requires patience and strict adherence to medical and physical therapy instructions. This journey takes many months, with each stage building upon the last to restore function and strength to the affected leg.
Managing the Acute Phase: Pain, Incision Care, and Initial Immobilization
The first one to two weeks following Achilles surgery constitute the acute phase, focusing on managing pain and protecting the surgical site. You will likely be discharged with a nerve block, but as it wears off within 24 to 36 hours, oral pain medication should be started promptly. A combination of narcotic and non-narcotic medications is often prescribed to manage the moderate-to-severe pain common during the first few days.
Controlling swelling is managed through elevation and icing protocols. The injured leg must be elevated above the level of your heart as often as possible, which significantly reduces swelling and pain. Icing should be applied frequently, often for 20 minutes every hour while awake, to minimize inflammation.
Initial immobilization typically involves a bulky soft splint or cast. This holds the foot in plantarflexion (a slight toe-down position) to keep tension off the healing tendon. Incision care requires vigilance to prevent infection; the splint must be kept clean and dry at all times, often requiring a plastic wrap during bathing. Monitor for signs of a serious issue, such as a fever above 101.5 degrees, increasing redness, or severe pain not relieved by medication. You will be strictly non-weight bearing, relying on crutches or a knee scooter, until your first post-operative appointment.
The Phased Transition to Mobility: Non-Weight Bearing to Walking
The transition from immobilization to independent walking begins around the second week after surgery. At the first follow-up appointment, the initial splint is removed, sutures or staples are taken out, and you transition into a controlled ankle motion (CAM) boot. This walking boot allows for a gradual change in the ankle’s position while protecting the repair.
Weight bearing progresses sequentially: from non-weight bearing (NWB) to partial weight bearing (PWB), and finally to full weight bearing (FWB). While some protocols keep the leg NWB for six weeks, others may allow touch-down weight bearing (TDWB) or PWB in the boot as early as two to four weeks post-surgery. The boot often contains removable heel wedges that are gradually taken out over several weeks, slowly moving the foot from a pointed position toward neutral.
The goal of this phase is to carefully load the healing tendon, stimulating repair without risking a re-rupture. Most patients progress to full weight bearing in the protective boot between six and twelve weeks after the operation. The CAM boot is slowly phased out as strength improves, typically occurring between two and three months, marking the return to regular supportive footwear.
The Foundation of Recovery: Physical Therapy and Long-Term Strengthening
Physical therapy (PT) is a non-negotiable component of recovery and represents the foundation upon which long-term function is restored. PT often begins soon after the surgical incision has healed and the boot has been applied, sometimes as early as two weeks post-surgery. The earliest goals of therapy focus on restoring ankle range of motion (ROM), specifically allowing the foot to move toward a neutral position without overstretching the delicate repair.
Once ROM goals are met, the focus shifts to rebuilding strength in the calf muscles, which atrophy significantly during immobilization. Exercises progress from gentle isometric contractions to resistance training, incorporating both concentric and eccentric loading. Eccentric exercises, where the muscle lengthens under tension, are often delayed until at least 12 weeks post-surgery to ensure the tendon can handle the stress.
The later stages of rehabilitation target functional recovery, including balance and proprioception (the body’s awareness of the foot’s position in space). This involves exercises like single-leg stance drills and multi-plane movements to prepare the leg for dynamic activities. The entire PT process is prolonged, often lasting six months or more, and requires a dedicated regimen of home exercises to maximize strength.
Timeline for Full Activity and Recognizing Complications
The timeline for returning to full activity varies widely based on individual progress and the type of activity.
Returning to Activity
Returning to sedentary work, such as a desk job, is often possible within a few days to a week after surgery, provided the pain is manageable and the leg can be elevated. Driving is usually restricted until the patient is completely out of the walking boot and can operate the vehicle safely, typically around the three-month mark.
More demanding physical activities require a longer, cautious progression to protect the healing tendon. Low-impact activities, such as stationary cycling or swimming, may be cleared around four months post-surgery. The return to running, jumping, and high-impact sports generally takes between six and twelve months, depending on the sport and demonstrated strength metrics. Full return is contingent on meeting performance-based milestones, not just the passage of time.
Recognizing Complications
It is important to be aware of complications that require immediate medical attention.
- Deep vein thrombosis (DVT): A blood clot signaled by severe calf pain, significant new swelling, or tenderness disproportionate to the recovery stage.
- Infection: Signs include fever, persistent drainage from the wound, or rapidly increasing redness around the surgical site.
- Re-rupture: Indicated by a sudden, sharp pain accompanied by a popping sensation, which demands immediate contact with your surgeon.