Accessory Navicular Excision — with Posterior Tibialis Tendon Advancement

Orthopaedic Associates of Maine

Weight-Bearing

NWB until 4 wks; FWB in boot by 6 wks; transition to supportive shoe with ASO brace by 8 wks

Key Restrictions

Short leg splint (ankle neutral) 10-14 days, then short leg cast to 4 wks; no active or passive ankle ROM phase I; avoid active inversion/eversion until cleared; no loaded plantarflexion initially; no barefoot walking; avoid high resistance or eccentric exercises until surgeon clearance; no running or jumping until later stages; discontinue boot 6-8 wks; night splint DC at 6 wks

Timeline & Phases

Phase I (Wks 0-4: NWB, splint/cast), Phase II (Wks 4-6: AROM, PWBFWB in boot), Phase III (Wks 6-12: shoe/ASO brace by wk 8, CKC, proprioception), Phase IV (Wks 12-24+: plyometrics, jogging 16-20 wks, RTS)

Notes

Jogging ~16-20 wks once single leg heel raise with good mechanics; agility 16-20 wks cleared by MD; 90% calf strength vs uninvolved for discharge; monitor posterior tibialis tendon for signs of tendinopathy