What is the Willets protocol?

The Willits Protocol: Early Mobilization for Achilles Tendon Rehabilitation

The Willits protocol is an early weightbearing rehabilitation protocol originally designed for Achilles tendon rupture treatment that allows patients to mobilize earlier than traditional immobilization approaches, resulting in improved outcomes and lower complication rates.

Overview and Application

The Willits protocol is a progressive rehabilitation protocol that emphasizes early controlled mobilization following Achilles tendon injuries or surgeries. While initially developed for Achilles tendon ruptures, it has been successfully applied to other Achilles-related procedures, including insertional Achilles tendinopathy surgeries 1.

Key Components of the Willits Protocol:

1. Early Protected Weightbearing:

   • Patients begin partial weightbearing shortly after surgery or injury
   • Uses a removable walking boot with controlled ankle motion
   • Progressive transition from protected to full weightbearing

2. Controlled Range of Motion:

   • Early introduction of controlled ankle movement
   • Gradual increase in range of motion exercises
   • Avoids prolonged immobilization that can lead to stiffness and atrophy

3. Structured Progression:

   • Follows a time-based progression of activities and exercises
   • Typically involves 2-3 minute stages with gradually increasing intensity
   • Similar to progressive incremental protocols used in other clinical settings 2

Evidence and Outcomes

Research has demonstrated several benefits of the Willits protocol compared to traditional immobilization approaches:

• Improved Pain Outcomes: Patients following the Willits protocol after Haglund's surgery showed an average decrease in pain from 6.14 to 1.53 on a 10-point scale 1

• Low Complication Rates: Only 3.4% of patients experienced post-operative rupture after trauma, and only 10.3% required reoperation 1

• Earlier Return to Function: The protocol allows patients to mobilize earlier than previously reported in the literature 1

Implementation Considerations

The Willits protocol follows principles similar to other standardized exercise protocols that emphasize:

1. Individualized Progression: While following a standardized framework, the protocol can be adjusted based on patient response and clinical judgment 2

2. Balanced Approach: Strikes a balance between protection of the healing tissue and prevention of complications associated with immobilization 2

3. Structured Stages: Uses defined stages with specific criteria for progression, similar to other established rehabilitation protocols 2

Clinical Application

When implementing the Willits protocol, clinicians should consider:

• Patient Selection: Most appropriate for patients without significant comorbidities that would impair healing
• Monitoring: Regular assessment of healing progression and compliance
• Adjustment: Modification of progression based on individual healing rates and response

Common Pitfalls and Considerations

1. Patient Compliance: Success depends on patient understanding and adherence to the protocol guidelines

2. Appropriate Supervision: Requires regular follow-up to ensure proper progression

3. Contraindications: May not be appropriate for patients with poor tissue quality, significant comorbidities affecting healing, or inability to follow instructions

4. Equipment Requirements: Necessitates appropriate orthotic devices to control weightbearing and range of motion

The Willits protocol represents a shift from traditional immobilization approaches toward early controlled mobilization in Achilles tendon rehabilitation, with evidence supporting improved outcomes when properly implemented and supervised.