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.

Pre-op Assessment

  • 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 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. 

2-6 Weeks

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. 


6-12 Weeks

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.