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Aaron WeyMD, FAAOS, FACSAdult and Pediatric Spine Surgery
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Foot and ankle · Post-op rehabilitation protocol

Posterior Tibial Tendon Reconstruction (FDL Transfer and Calcaneal Osteotomy)

After posterior tibial tendon reconstruction: no weight bearing for four weeks, walking cast and boot to week ten, brace to month six, cleared at nine months.

This is the rehabilitation plan I ask your physical therapist to follow after this operation. Bring it to your first therapy visit. It is a framework, not a prescription: your therapist adjusts the pace to how you are healing, and anything we discussed in the office takes precedence over what is printed here. If something on this page does not match what we talked about, ask me.

Physical therapist: please send progress notes to the office at (201) 836-1663 and call with any question about the plan.

Days 1–28

Exercises

  • Immobilized in equinus and varus
  • Crutches – non weight bearing (NWB)
  • Active range of motion (AROM) hip and knee
  • Wiggle toes
  • Straight leg raises (SLR) x 4 directions
  • Short arc quad (SAQ)
  • Upper body exercises (seated or bench only – no pushups)
  • LE stretches – Hamstring, quads, ITB, hip flexors
  • Elevation

Goals

  • Pain management
  • Prevent swelling

Weeks 4–8

Exercises

  • Short leg walking cast SLWC – Positioned more plantigrade
  • Crutches – weight bearing as tolerated (WBAT), D/C when gait is normal
  • Continue appropriate previous exercises
  • Isometrics x 4 directions

Goals

  • Minimize atrophy

Weeks 8–10

Exercises

  • Cam walker – full weight bearing (FWB)
  • Continue appropriate previous exercises
  • Scar massage/mobilization with oil/cream
  • Ankle AROM – Calf pumping, alphabet, rotations
  • Light Theraband ex x 4
  • Towel crunches and side-to-side
  • Steamboats (Theraband x 4 while standing on involved LE) in cam walker
  • Mini-squats, Wall squats, Total gym
  • Proprioception ex – Double leg BAPS
  • Gastroc/Soleus stretching

Goals

  • Full DF / PF
  • No adhesions

Weeks 10–16

Exercises

  • Transition from cam walker to ankle brace
  • Continue appropriate previous and following exercises without brace
  • Strengthening ex, emphasize medial ankle mm
    • Theraband with increasing resistance
    • Elgin
  • Double leg heel raises – emphasize involved side
  • Leg press, knee ext, Hamstring curl, hip weight machines
  • Forward, retro and lateral step downs
  • Proprioception ex – single leg BAPS, ball toss, body blade
  • Stationary bike
  • Pool therapy

Goals

  • Normal gait
  • Symmetrical ROM

Months 4–6

Exercises

  • Continue ankle brace and appropriate previous exercises
  • Single leg heel raises
  • Fitter, slide board
  • Treadmill – Walking progression program
  • Elliptical trainer
  • Stairmaster

Goals

  • Normal strength
  • Walk 2 miles at 15 min/mile pace

Months 6–9

Exercises

  • D/C brace
  • Continue appropriate previous exercises
  • Pushup progression
  • Sit-up progression
  • Treadmill – Running progression program
  • Agility drills / Plyometrics
  • Transition to home / gym program

Goals

  • Return to all activities
  • Pass a return-to-sport / fitness test at 9 months post-op
  • No contact sports until 9 months post-op

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from William Beaumont Army Medical Center, Physical Therapy Section, "Posterior Tibial Tendon Recon WB08", Revised August 2008, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: Posterior Tibial Tendon Recon WB08.pdf. Army-specific wording in the original (APFT) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.