Anterior Tibial Tendon Reconstruction

Postoperative Rehabilitation Protocol: Anterior Tibial Tendon Reconstruction

Phase I: Protection and Healing (0–4 Weeks)

      •     Weeks 0–2:

      •     Immobilization in a posterior splint.

      •     Strict non-weight-bearing (NWB) with crutches/knee scooter.

      •     Elevation and icing to manage swelling.

      •     Toe range of motion (ROM) exercises (avoiding tension on the reconstructed tendon).

      •     Weeks 2–4:

      •     Transition to a cast.

      •     Continue strict NWB.

      •     Monitor for signs of healing and ensure proper alignment.

Phase II: Transition to Controlled Mobility (4–8 Weeks)

      •     Weeks 4–6:

      •     Transition to a walking boot with NWB.

      •     Begin gentle isometric exercises for surrounding muscles (e.g., quadriceps, glutes) to maintain strength.

      •     Continue toe ROM exercises.

      •     Weeks 6–8:

      •     Progress to partial weight-bearing in the boot as tolerated (start at 25% body weight and advance weekly).

      •     Introduce active-assisted ankle dorsiflexion exercises (gravity or manual assistance) to engage the anterior tibialis without overloading.

      •     Ankle passive ROM within a safe range (avoiding excessive dorsiflexion stress).

Phase III: Strengthening and Functional Recovery (8–16 Weeks)

      •     Weeks 8–10:

      •     Full weight-bearing in the boot.

      •     Begin active ankle dorsiflexion strengthening with minimal resistance (e.g., light therabands).

      •     Progress ankle ROM exercises, including plantarflexion, inversion, and eversion.

      •     Initiate light proprioceptive training (e.g., seated BAPS board).

      •     Weeks 10–12:

      •     Transition from the boot to a shoe with a drop foot AFO.

      •     Advance dorsiflexion strengthening with increasing resistance (moderate therabands).

      •     Introduce functional weight-bearing exercises, such as heel raises (starting with seated, then progressing to standing).

Phase IV: Advanced Strengthening and Return to Activity (4–6 Months)

      •     Months 4–6:

      •     Discontinue the AFO at 4 months if gait mechanics are normal and there is no evidence of foot drop.

      •     Advance dorsiflexion strengthening to functional movements (e.g., toe taps, resisted dorsiflexion with weights).

      •     Focus on proprioceptive training (e.g., single-leg balance, wobble board).

      •     Gradual return to low-impact activities, such as cycling or swimming.

Phase V: Return to Full Activity (6+ Months)

      •     Progress to sport-specific activities as tolerated.

      •     Continue strengthening dorsiflexion and other ankle movements.

      •     Use AFO or supportive devices for high-demand activities during the transition if needed.