Rehabilitation Principles, Early Loading, Bracing and Heel Raises

With no trials of active versus no rehabilitation, recommendations draw on an international consensus and the guideline group. Common principles are early loading, attention to kinesiophobia, training to the capacity the patient needs, and clear education. Many surgeons expect return to sport within three to four months, sooner than physiotherapists usually see. Realistic expectations: normal daily function in 3 to 6 months, about 80 percent back at work after 2 to 3 months, and 52 percent back in sport after a year, with initial return around six months and age a major factor. Early loading, defined as full weight bearing within three weeks, did not change function or re-rupture rates and brought return to work about two weeks sooner. The guideline advises partial weight bearing for two weeks and full weight bearing after that, and a reusable brace rather than repeated casts for six to eight weeks. Heel raises of 4.5 down to 2 cm aim to limit tendon elongation, which reduces plantar flexion strength high on the toes.