Physical Therapy After Posterior Tibial Tendon Surgery

If you have posterior tibial tendonitis (or posterior tibial tendon [PTT] dysfunction, as it is commonly called) you may benefit from physical therapy to help decrease pain and improve your overall mobility. Occasionally, your pain or limited mobility may continue even after your best efforts in PT, and you may require a surgical procedure to correct your problem. If you do require surgery for PTT dysfunction, you may benefit from physical therapy after surgery to help you recover fully.

The focus of physical therapy after posterior tibial tendon surgery is to help you regain normal range of motion and strength in your ankle, knee, and hip. Ultimately, the goal of your PTT dysfunction post-op rehab is to return to optimal functional mobility.

Why Have PTT Surgery?

The most common reason to have posterior tendon surgery is to correct pain and limited walking ability due to acquired flatfoot deformity. Your posterior tibialis tendon helps to support your foot's natural arch. When this tendon gets overstressed, it can be painful, tear, and ultimately cause your foot's arch to fall. Surgery is done to correct this problem and help you return to your normal activity level.

During your surgery, your healthcare provider will make an incision in your ankle and the damaged posterior tibialis tendon will be repaired. It may be removed entirely, and another tendon from your foot may be grafted in place. After the procedure, the incision will be closed, and your foot will be bandaged. Most PTT tendon procedures are performed on an outpatient basis; you will likely go home the day of your surgery.

First Steps

After PTT surgery, you will likely be wearing a dressing over your surgical incision. You may also be wearing a removable CAM boot—a special boot with velcro straps that protects your foot and ankle as things are healing.

Your healthcare provider will likely also have you walking with crutches. Typically after PTT surgery, patients walk with a non-weight bearing gait pattern for a few weeks. As things heal, you may progress from non-weight bearing to toe-touch and partial weight-bearing, and finally to walking with a full weight-bearing gait pattern. Your practitioner can tell you what your exact weight-bearing protocol is after surgery, and a physical therapist can help you progress with proper gait and walking.

PT Evaluation

When you first present to physical therapy after your PTT surgery, your physical therapist will perform an initial evaluation. During this session, your PT will ask you questions about the history of your condition and how it led to surgery. Be prepared to answer questions about your work and recreational activities and about any limitations you may have as a result of your injury and surgery. These questions help your PT determine the ways that your condition affects your overall function and lifestyle.

After taking a history, your PT will perform an examination. Different components of this examination may include:

• Gait evaluation: Your PT will watch and analyze how you are walking. He or she will check if your assistive device is properly sized and if you are exhibiting any unsafe motions or movements while walking.
• Palpation: Palpation involves your therapist touching various parts of your foot and ankle to look for signs of inflammation, swelling, or other problems.
• Measures of range of motion (ROM): Your physical therapist will use a goniometer to measure how far your ankle is moving in various directions.
• Strength measurements: Measures of strength may be taken for specific muscle groups around your ankle.
• Scar assessment: Your PT may check your surgical scar to ensure that things have healed properly. Scar mobility may be assessed to look for signs of adhesions or limited scar motion.
• Volumetric measures of your foot and ankle: Your PT will check to see if there is any swelling around your ankle and foot.

Once your therapist collects the data about your current condition, he or she can work with you to develop goals for your post-operative rehab. Goals typically include:

• Restore normal lower extremity ROM
• Restore strength to your ankle, knee, and hip
• Normalize walking
• Improve balance
• Help you regain maximal function including returning to normal work and recreational activity

These goals form the basic framework for your PTT physical therapy program. They should be addressed at regular intervals, and they should be adjusted based on how you are progressing with your therapy.

After the initial evaluation, your physical therapist may begin treatment for your posterior tendon surgery.

Physical Therapy Treatment

Treatment after PTT surgery may vary based on your condition, your PT, and your overall needs as a patient. Your rehab program should be individualized and geared specifically to your needs.

Physical therapy after surgery for your posterior tendon may include various treatments. Each treatment and modality should be used to augment your rehab and help you achieve your PT goals. Treatments may include:

• Exercise: Exercise should be your main treatment in PT after posterior tendon surgery. Exercises should be specific to your condition and initially may focus on regaining normal ROM and strength. The exercise program can be progressed to more advanced balance and functional exercises as you continue with rehab. A home exercise program may be initiated, so be prepared to have some homework in order to get your ankle and foot moving normally again.
• Manual techniques: Sometimes, your PT needs to use his or her hands to help improve the way your ankle moves after PTT surgery. After a period of immobilization, the joints of your ankle and toes may be stiff, and joint mobilizations may be necessary to improve overall mobility. Manual stretching of the muscles of your lower leg may be needed as well. Your therapist may also need to strengthen your ankle muscles using manual resistance exercise.
• Scar massage: If your PT determines that your scar has adhered to the underlying tissue, scar tissue massage may be performed. These techniques are used to help improve the way your scar glides and slides over the fascia and tissue that lies just below your skin.
• Gait training: One goal of rehab after PTT surgery is to restore normal walking, so gait training may be done during your therapy sessions. Your therapist can perform specific exercises to help improve the way you are walking. He or she may also make recommendations about the type of assistive device you should be using during the post-operative period to ensure you progress properly and safely with walking.
• Anti-inflammatory treatments like ultrasound or electrical stimulation: Your therapist may choose to use various therapeutic modalities to augment your rehab. Ultrasound is occasionally used to increase circulation around your foot and ankle, although research into its use indicates that it does not improve the overall outcome of therapy. Electrical stimulation for pain and swelling control may be used, and neuromuscular electrical stimulation may be chosen to improve the way your muscles around your foot and ankle contract.
• Heat and ice: Hot packs or ice may be used during your therapy to improve circulation and control swelling around the surgery site.

Be aware that the use of passive modalities like ultrasound or e-stim after PTT surgery is not supported by scientific literature. The best treatment for your ankle after PTT surgery is active exercise and movement.

The relationship you have with your PT should be a close one; working with your PT should feel like a therapeutic alliance where you are both working together to achieve your rehab goals. If you have questions about your care, just ask. If things are not going to plan or if you have concerns, tell your PT so you can both work together to maximize your chances of a full recovery.

How Long to Get Back to Normal?

Most courses of rehab after PTT surgery take about four to eight weeks. Does this mean you'll be fully healed at that time? Maybe, but maybe not. Some patients discontinue PT to work independently to fully recover from this surgical procedure. Your individual course of rehab may be a little longer or a little quicker. Be flexible, and be sure to work closely with your healthcare provider to know exactly what to expect after PTT surgery.

A Word From Verywell

If you have had surgery for posterior tibial tendonitis, you may benefit from physical therapy to help you fully recover and to return to your previous level of function. Your physical therapist can be your guide to help you regain normal motion and strength and to get you back to your normal activity level. By working hard in physical therapy, you can be sure to quickly and safely return to your previous activities.