Our week-by-week guide to the best non-surgical treatment for complete Achilles tendon ruptures. Including how to use your orthopaedic boot, what exercises to do, how to walk normally again, and how long it will take for your ruptured Achilles to heal. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

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Key features of a non-surgical treatment plan
There is currently no consensus on the best way to manage complete Achilles ruptures without surgery. However, the results of research studies do suggest some elements that might improve the end results.
These include:
Complete immobilization in maximum plantar flexion (toes pointing down) in a cast or an orthopaedic boot for about 10 to 14 days – this is so that the ends of the ruptured tendon can grow together again.
Then, starting to place weight on the leg with the foot still in the boot (around three weeks after rupture), while gradually decreasing the plantar flexion angle over several weeks. Early weight-bearing in this position helps the tendon to regain its strength without stretching it too much.
After six to eight weeks, start to introduce movement into all directions, but initially avoiding strong dorsiflexion (toes pointing up, towards the shin) stretches.
Wearing supportive shoes with a raised heel when you first remove the boot helps to bridge the gap between the support of the orthopaedic boot and not having any support (unsupportive, flat shoes) and avoids strain injuries to the foot and the Achilles tendon.
💡These protocols will vary slightly from case to case because they must be adapted to every patient’s specific situation (speed of healing, extent of injury, other medical conditions, ultimate activity goals, etc.).
Step-by-step rehab guide
Here is a week-by-week breakdown of what a typical conservative treatment protocol for complete Achilles ruptures might look like if you combine the best practices from the most current research.
First 10 to 14 days: Total immobilisation
Boot or cast setup
Your foot might be placed in a plaster cast, a boot with hinges (like VACOped), or a boot without hinges (like Aircast) with heel-raising inserts.
Regardless of the method used, it is important that the foot is positioned in 30 degrees plantar flexion (or the maximum angle at which your foot and ankle can comfortably point down).

For a hinged boot, this is achieved by simply locking the hinges in place.
If using a boot without a hinge, add enough heel lifts (about 2 inches or 5 cm thick depending on foot size) to achieve the 30-degree angle.
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💡 For the best result, it’s crucial that you wear the boot 24 hours a day for the first two weeks; some surgeons prefer a plaster cast because the patient cannot remove it.
Walking advice
Use crutches and avoid putting any weight through that leg when you stand or walk.
General advice
Try to elevate your leg as much as possible to reduce swelling.
🚨You’re at increased risk of developing a blood clot (DVT or deep vein thrombosis) during the first few weeks, so keep an eye out for the typical symptoms and contact your doctor immediately if you experience any.
Ankle and foot exercises
None.
Rest of the body
It’s important to not overdo things during this phase. I usually advise my patients to not do exercise during the first week of recovery.
If they’re keen to avoid losing strength in the rest of their body, I might advise them to start with exercises that don’t involve their injured Achilles tendon only during the second week.
Examples:
Core exercises lying down, e.g. sit-ups, crunches, and Russian twists
Upper body exercises lying down or sitting, e.g. seated rows, push-ups on knees, overhead press.
💡It’s best to avoid exercises that work the uninjured leg during this time – that poor leg will already be doing double its normal work.
Also, bear in mind that you’re not allowed to remove your boot at all, so it might not be a good idea to get too sweaty.
Start of Week 3: Early mobilisation and full weight-bearing
If you’ve been in a plaster cast, it will usually be removed at this stage, and you’ll be issued with a boot.
Boot setup
If using a boot with dynamic hinges (like VACOped), the hinges are adjusted to allow the foot to move between 20 and 30 degrees of plantar flexion.
If using a rigid (e.g. Aircast) boot, one or two heel lift insert are removed to adjust the foot position to about 20 degrees plantar flexion (about 1.3 inches or 3cm high depending on foot size) .
Continue to wear the boot 24/7.
Walking advice
You’re usually allowed to place all your weight on your injured leg as long as you wear your boot.
Continue to use crutches or a stick to help you balance.
Wear a thick-soled shoe with an EVENup shoe leveller on the uninjured side to help with your balance and to avoid straining your back.
Here are examples of thick-soled Hokas, as well as the EVENup shoe leveller:
Ankle and foot exercises
Gentle isometric eversion, inversion, plantar flexion, and dorsiflexion can be useful to start rebuilding strength.
Your foot must remain in your boot when you do them.
You gently push against resistance (the inside of your boot in this case), but you don't actually move your foot.
Do NOT push as hard as you can – aim for 50% of your maximum effort.
Hold the push for about 10 seconds, and do 10 repetitions into each direction up to 3 times a day.
Push down for plantar flexion.
Push up for dorsiflexion.
Push into the inner side of the boot (as if you want to turn your foot in) for inversion.
Push against the outer side of the boot (as if you want to turn your foot out) for eversion.
Rest of the body
You can usually add in some leg strength exercises, e.g.:
Side leg lifts
Clams
Resisted leg curls using an exercise band
Resisted knee extension – for the injured leg, the weight of the boot might be enough, but for the other leg you can use an exercise band.
Start of Week 4: Increase range of motion
Boot setup
If using a VACOped-type boot, the dynamic hinges are adjusted to allow the foot to move between 16 and 30 degrees of plantar flexion.
If using an Aircast-type boot, remove more heel lifts to adjust the foot position to about 16 degrees plantar flexion.
Walking advice
Same as before.
Ankle and foot exercises
Same as before.
Rest of the body
Same as before.
Start of Week 5: Begin with range of motion exercises
Boot setup
The boot is adjusted to about 10 degrees plantar flexion.
Wear the boot when standing and walking.
You can usually take off the boot at night and to do exercises.
Walking advice
Same as before.
Ankle and foot exercises
Continue with the isometric exercises inside your boot.
You can usually also remove your boot and do ankle range of motion exercises, making sure your ankle does not bend up past 0 degrees dorsiflexion (preferably keeping the toes pointed to some extent).

Exercises include:
Free active inversion and eversion movements while keeping the foot pointed down into plantar flexion.

Free active plantar flexion and dorsiflexion up to 0 degrees dorsiflexion (neutral) or less if you start to feel a pull in your Achilles tendon.

Rest of the body
You may be allowed to add in non-weightbearing exercise like cycling, but you have to wear your boot while cycling and keep the resistance low.
Weeks 6 and 7: Plantar flexion to neutral
Boot setup
Adjust the boot’s hinges or remove all the wedges to allow movement between 0 and 30 degrees plantar flexion.
Walking advice
Continue to wear the boot when you walk and stand.
Use crutches if needed.
Practice using a more normal gait pattern, placing the heel of the boot down first and rolling through the length of the sole so that the front leaves the floor last. It is usually easier to do this with the VACOped boot because of its rocker bottom.
Ankle and foot exercises
You can usually start gentle calf strengthening exercises but avoid moving into dorsiflexion (so stop when the ankle is in neutral).
🚨 Important – These exercises must be practised under the supervision of a physiotherapist before you start doing them at home.
Examples include:
Seated calf raises
👉 If you feel a strong stretch in your Achilles, move your feet slightly further forward (away from the chair). Do not move past 0 degrees dorsiflexion.
Resistance band exercises
You can usually start strengthening your ankle into all directions using an exercise band (still no dorsiflexion past neutral). Concentrate on slow and controlled movements.




Foot arch exercises to keep your smaller foot muscles strong and engaged. Gathering a towel with your toes can work well.

👉 Have your foot further forward from the chair to avoid getting dorsiflexion in the ankle.
Rest of the body
Same as before. Whenever you stand, check that you have equal weight on your injured and uninjured legs. This will make the transition to normal walking much easier in the next phase.
Weeks 8 to 12: Discard the boot
Boot setup
Remove the boot completely and replace it with a supportive shoe with a raised heel of about 10 mm higher than the front of your foot. Most running shoes can work, but you can also add heel-raising inserts into your shoes if they are too flat. We’ve discussed the key features of the ideal shoes after wearing a boot in this article.
Initially, you can use one crutch to help you balance, but you should aim to discard it after a week or two.
💡 Check that you distribute your weight equally between your injured and uninjured leg when standing. Correcting this regularly will help you walk and move more normally.
Walking advice
Get used to walking without the boot and concentrate on using a normal walking pattern (landing with the heel first, then touch down with the middle of the foot, until you finally push off with the toes.
Calf and Achilles exercises
👉 You should wear your shoes during all of these exercises to avoid excessive dorsiflexion.
You can now ease into stronger exercises, e.g. double-leg calf raises (more weight on the uninjured side initially) and seated calf raises with added weights.
Standing calf raises
First, get comfortable doing:
10 repetitions, slowly up and slowly down,
with 75% of your bodyweight on the uninjured leg and only 25% on the operated one,
5 times a day (these can be spread out, but if you’re doing them in one go, rest at least 60 seconds between sets).

Once that is easy, gradually increase the reps until you can easily do 5 x 25 reps in a day.
Then, aim to:
place a bit more weight on your operated side,
and build up to doing 5 x 25 reps with 50% of your bodyweight (so, equal weight on both legs).
Finally, shift more weight over to your injured side (about 75%) and build up to doing 5 x 25 repetitions.
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💡 These repetition goals are what I would typically prescribe for an active person who does sports. If you are less active or perhaps quite unfit, your goals will likely be much lower.
Calf and Achilles strength while sitting
Doing seated calf raises with a light weight placed on your thighs is another excellent way to build strength. Make sure to lift through the full range of plantar flexion and concentrate on lowering down slowly.
Balance
You can usually practice tandem stance or single-leg balance, but place one hand against a wall for extra stability.
Rest of the body
Start doing full body exercises using your bodyweight only, concentrating on distributing your weight equally between your legs and controlling the movements properly. The slower you do them, the better control you will develop.
Examples (all with double-leg support):
Squats
Good mornings
Bridges
For leg strength, you can also add in:
Leg curl machine
Knee extension machine
Leg press machine (pushing through heels for now rather than front of foot and keeping resistance on the low side).
After 12 weeks: Progressive strength and agility training
Walking
As soon as you’re able to walk with a near normal gait pattern, you can usually start walking for exercise.
It’s best to:
Start with short walks (you can increase the distance as your Achilles gets stronger)
Keep the pace very slow (think stroll rather than power walk)
Wear good supportive shoes
Leave at least one full recovery day between walks.
Rehab exercises
Your physio will guide you to gradually increase the resistance and load in your exercises. The aim is to properly prepare your Achilles tendon, calf muscles, and the rest of the body for the movements and forces they have to cope with during your goal activities and sport.
What exercises you do and what you build up to will be determined by:
your ultimate activity goals
your general health and fitness
restrictions from old injuries.

Calf raises will transition to single-leg ones, over the edge of a step, and later with added weight. It is important to restore full strength before attempting hopping or running.
If your goal is to get back to sports that involve jumping or running, your physio will likely also prescribe bounding calf raises and plyometric exercises (hopping and jumping) in the final stages of rehab, just before you return to full sport.

For sports requiring quick changes of direction, you will also be prescribed agility drills that increase in speed.
Core and full body exercises will become progressively more challenging and involve a lot of single-leg loading to challenge your balance and control and to ensure that you’re not compensating by overusing your uninjured side.
There is no set timeline for adding or progressing these exercises – these should be done on an individualised level because we all recover at different rates.
🎯 Your physio will set you specific exercise targets you must hit before progressing to the next level. However, you should not try and rush it – your body needs time to strengthen in response to these exercises. So, in certain cases, doing the same exercises at the same intensity for several weeks will be required.
How long before I can do sport again?
Most people can get back to jogging after six months. But if your sport requires forceful accelerations, quick changing of direction, and jumping, expect it to take at least nine months to get back to full sport.
How we can help
If you suspect that you’ve torn your Achilles tendon, the first step should always be to see a doctor or physio in person who can diagnose it for you and can immobilise your foot in plantar flexion (foot pointing downwards, away from your shin) in a boot and/or refer you for surgery if appropriate.
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For the first 12 weeks after you’ve torn your tendon, it is usually best to consult a physiotherapist in person.
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Our role starts once you’ve been cleared to start removing your boot (around 12 weeks post-rupture). It is only at this point that we can safely take over your rehab via video call.
Who we are
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.