Posterior Tibial Tendon Reconstruction

Mountain Orthopaedics · Mountain Ortho Clinical Team

Weight-Bearing

NWB x 6 wks; WB 25% per week in boot starting wk 7; unrestricted WB after wk 12 if radiographic union

Key Restrictions

Complete immobilization in boot/cast wks 1-6; boot with orthotic wks 7-12; ASO lace-up brace with medial strap and orthotic wks 12-24; orthotic in all shoes long-term; increased swelling/pain may indicate incomplete bone healing - reduce WB and therapy demands accordingly

Timeline & Phases

Pre-op training 1 wk before surgery; Phase I Immobilization (wks 0-6, NWB); PT begins after 6 wks immobilization; Phase II Early Rehab (wks 7-12, boot with orthotic, 25% WB/wk, AROM only first 2 wks then passive if needed, isometrics then progress CKC to OC); Phase III Brace/Return (wks 12-24, ASO brace, unrestricted WB if radiographic union, proprioception progression)

Notes

Reconstruction often includes osteotomies with bone healing requirements; PT delayed until 6 wks post-op; must achieve dorsiflexion and inversion ROM; strength goal: PF and inversion with single-leg stance; proprioception goal: single-leg balance eyes closed 20 seconds; orthotic required long-term in all footwear

Surgeon / Author

Mountain Ortho Clinical Team