Tendons are usually transferred in conjunction with bony procedures, precautions always default to the MOST restrictive protocol.
This is a standard program; any unusual circumstances noted by MD or therapist should be clarified and protocol modified as warranted.
For specific tendon transfer explanations and detailed protocols, click here.
- Patient goals
- Screen medical/mobility history.
- Current level of function: ADLS, mobility, measure range of motion.
- Home environment: Equipment/ Modifications needed. (Patient to obtain)
- Assistance available?
- Home health PT eval needed?
Train home exercise program for after surgery:
- General exercise program: AROM hip, knee and toes; quad/glut sets; U.E. exercises.
- -Instruction in exercises specific to particular surgery:
- Patient training to avoid stressing transferred tendon—no active movement or stretching of transferred tendon musculature.
- Assist Devices: Crutches for gait. Will need walker if bilateral foot procedures performed. May need W/C if bilateral.
- Family/caregiver training as needed.
- Relaxation techniques.
- Edema management
- Bed “rest” with leg elevated 8-10 inches until cleared by MD.
- Bed exercises for joints above and below surgical sites, no active movement or stretching of transferred tendon musculature (except OK to move toes).
- Limit time with extremity dependent.
- Gait training with device. Weight bearing status will depend on type of surgery.
- NWB at least 2 weeks but may be NWB up to 6 weeks post op.
- Girdlestone-Taylor (for Hammer Toe Reconstruction) or Extensor Substitutions performed in isolation follow Gastroc Slide precautions except that boot should be worn for 4 weeks day and night, then 2 more weeks at night only.
- Verify equipment status.
- Sample exercises for home exercise program: Foot intrinsics (MTP flexion with PIP/DIP extension, gentle isometrics of non-operative tendons in cast.
- Note: Girdlestone-Taylor will have no available active IP toe flexion as it will be fusing/fused.
At 2 weeks: Splint removed, sutures out. Edema control training. CAM boot or hard cast placed. Beginning scar massage if out of cast.
- Continue with hip, knee, UE exercises. Gentle isometrics of non-operated muscles/tendons O.K. No AROM or stretching of transferred tendon.
- Continue crutch (or other device) gait with WBAT.
- Home exercise program
- General rule: Gentle passive ROM of transferred tendon towards origin (slack position) is OK. Gentle AROM in opposite direction (contraction of antagonist) OK but only to neutral.
- For example, if P.tib. is transferred to Tib. Ant., active plantarflexion to reach neutral and passive dorsiflexion are allowed.
6-7 week MD visit: Out of cast, into CAM boot unless otherwise specified by MD. X-ray.
- Pt. teaching: Edema control (may need support stockings), teach scar mobilization, desensitization.
- If cleared by MD, AROM transferred tendon musculature with boot off @ least 3 times a day. By 10 weeks, light theraband resistance exercise.
- Gait training: If not already WBAT at 6 weeks progress to full weight bearing over approx. 4 weeks in CAM boot per MD instructions.
- Wean off assistive device.
- Sample exercises for home exercises: Ankle pumps, alphabets, arch lifts in sitting. Foot intrinsic (MTP flexion with PIP/DIP ext). Gentle AAROM to gain range.
- Low impact conditioning:
- Pool therapy, exercises, stationary bike with boot on.
12 weeks to 5 months
12 week MD visit.
- When comfortably FWB, wean out of CAM boot into shoe. Shoe modification if needed. May need crutch/cane when first out of CAM.
- OK to push stengthening at 12 weeks, resistance exercises for transferred tendon muscles, stretching for range.
- -Progressive stretching—start with towel stretch, progress to standing.
- Progress to closed-chain exercises, single-leg-stance, balance and proprioceptive exercises.
- Sample exercises for home exercise program:
- Mini squats. Stationary single leg stance activity.
- Sitting foam, Baps/wobble board work progressing to standing.
- Towel plantarflexor stretches.
- “Quality” walking using heel>lateral foot>great toe pattern focusing on toes pointing straight ahead and splaying the toes out wide at push-off.
- Standing heel raises/toe raises. Medial longitudinal arch raising in stance.
5 month to D/C
5-6 month MD visit.
- Maximize quality of gait. Advanced balance, proprioceptive work. Prepare for DC. Assess need for modified shoes/ orthotics.
- Sample exercises for home exercise program:
- Stance calf stretching, with STJ in neutral position.
- Standing BAPs/wobble board.
- Advanced single leg stance exercises.
- Functional testing.