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Posterior Tibial Tendon Reconstruction

John G. Kennedy, MD, FRCS, Lower Limb, Foot and Ankle, Cartilage Restoration, Orthopedic Surgeon, West Palm Beach, New York / Foot & Ankle / Post-op Protocols / Patient Surgery Binder / Posterior Tibial Tendon Reconstruction

This protocol provides you with general guidelines for initial stage and progression of rehabilitation. Please note this protocol is a guideline. Specific changes will be made by the physician as appropriate for the individual patient.

Weeks 0-2

General

  • Remain non weight bearing in a splint
  • Maintain dressing, keep dry
  • Icing and elevating is encouraged to alleviate swelling

Weeks 2-4

General

  • Come into office for suture, splint removal
  • Transition into tall CAM Boot and start 10% weight bearing daily
  • Use crutches/knee scooter to assist with ambulation

Goals

  • Decrease pain and swelling

Exercises

  • Start range of motion (ROM) exercises

Weeks 4-8

General

  • Come into office for X-Ray
  • Advance to full WB gradually over the next 2-4 weeks in the CAM boot (Increase 10% of body weight per day) as tolerated

Goals

  • Decrease pain and swelling
  • Reduce stiffness

Exercises

  • Continue ROM and plantar flexion/dorsiflexion exercises

Week 6+

General

  • Start physical therapy

Goals

  • Transition into sneakers with assistance from Physical Therapy
  • Improve ROM
  • Improve balance and proprioception
  • Increase strength and flexibility

Return to full unrestricted activity or sports when cleared by a physician

General Post-Operative Care

Dressings

  • Maintain primary dressings until the two week mark post-surgery, unless otherwise instructed by your provider.
  • Have a water proof cover available to protect your dressing or splint while in the shower.

Infection

  • Observe for any signs of infection including redness, warmth, dehiscence or opening of the incision, or drainage at the incision site. Notify your provider right away if you experience any of these symptoms.

Pain Management

  • Talk to your doctor about your pain medication regimen before and after surgery. Usually, prescription pain medications can be taken every 4-6 hours. OTC Tylenol can be taken for breakthrough pain, the maximum dose for Tylenol is 3,000 mg per day for adults.
  • OTC stool softeners may be taken concurrently with your prescription pain medication to reduce the risk for opioid induced constipation.
  • Pain medications commonly have a side effect of drowsiness. Refrain from any activities that require strict attention after taking these medications (ie operating heavy machinery, driving, etc).

Swelling

  • Icing and elevating the affected extremity above the level of the heart can help alleviate swelling. Icing can be done 2-3 times a day or as needed.
  • Avoid applying the ice directly on your skin for a prolonged period of time as this may cause blisters.

Range of Motion (ROM)

  • Once your splint is removed, Range of motion exercises are encouraged to reduce stiffness.
  • In the ankle, ankle pumps (dorsiflexion and plantar flexion exercises) for 5-10 minutes about three times is encouraged.
  • In the toe, flexion exercises of the joint are encouraged.

Deep Vein Thrombosis (DVT)

  • Talk to your provider about Prophylaxis treatment for Deep vein thrombosis (DVT) needed for your surgery.
  • Antiplatelet and anticoagulant medications can increase your risk for bleeding and bruising.
  • If you experience any severe calf pain, leg swelling, along with chest pain and shortness of breath, call 911 or go to the nearest hospital as this can be a sign of a life threatening condition.