Posterior Tibial Tendon Reconstruction — Complete Exercise Program

Elevation & Swelling Control

Reduces swelling and supports healing in the first weeks.

What it helps: Bringing the leg up reduces swelling and supports healing in the early weeks — simple, and it speeds your comfort.

1. Lie back and prop the foot above the level of your heart on pillows.
2. Rest like this regularly through the day, especially after being up.
3. Use ice as directed by your surgeon.

Tips:

• Elevation is one of the most helpful things you can do early on.

Commonly done several times a day.

Toe Flexion & Extension

Keeps the toes moving and blood flowing while the ankle is protected.

What it helps: Keeps the toes moving and the blood flowing while the foot heals.

1. Curl your toes downward, then straighten and spread them upward.
2. Move only the toes — keep your ankle still in the boot or cast.

Tips:

• A gentle way to stay active in the first weeks.

Commonly done as 15-20 repetitions, a few times a day.

Ankle Pumps

Improves circulation and helps reduce swelling.

What it helps: Keeps blood moving to reduce swelling and the risk of clots while you're less active — small, frequent, and important early on.

1. Flex your foot up, pointing your toes toward the ceiling.
2. Point your toes down, away from your body.

Tips:

• Move slowly and with control.

Commonly done as 20 repetitions, several times a day.

Quad Sets

Re-activates the thigh muscle and supports knee control.

What it helps: Wakes up the quadriceps — the big thigh muscles that support and control your knee. Getting them firing is the foundation of a strong, steady leg.

1. Sit or lie with your leg straight.
2. Tighten the muscle on top of your thigh, pressing the back of your knee down.
3. Hold briefly, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Glute Squeezes

Gently re-engages the buttock muscles.

What it helps: Wakes up the glutes — the big muscles that steady and support your hip. Getting them firing again is the first step toward a hip that feels stronger and carries you with less strain on the joint.

1. Lie or sit comfortably.
2. Squeeze your buttock muscles together.
3. Hold a few seconds, then relax.

Commonly done as 2-3 sets of 10, a few times a day.

Straight Leg Raises

Strengthens the thigh while protecting the joint.

What it helps: Builds quad and hip strength while the knee stays straight, so the muscle works hard without stressing the joint.

1. Lie down with one leg bent and the other straight.
2. Tighten your thigh and lift the straight leg a few inches.
3. Lower slowly.

Tips:

• Keep the knee straight as you lift.

Commonly done as 2-3 sets of 10, once or twice a day.

Hip Abduction

Strengthens the outer hip while you stay off the foot.

What it helps: Strengthens the outer-hip muscles that keep your hip level and steady — strength you can build without putting any weight through your healing foot.

1. Lie on your side with the surgical leg on top, legs straight.
2. Lift the top leg upward a comfortable distance, keeping it in line with your body.
3. Lower slowly.

Tips:

• Keep your toes pointing forward, not up toward the ceiling.

Commonly done as 2-3 sets of 10, daily.

Core Activation

Gentle core engagement to support posture and balance while you recover.

What it helps: Switches on the deep core muscles that stabilize your pelvis and spine, giving your hips a solid platform to move from.

1. Lie or sit comfortably.
2. Gently draw your belly button toward your spine.
3. Hold a few seconds while breathing normally, then relax.

Tips:

• Avoid holding your breath.

Commonly done as 2-3 sets of 10, daily.

Gentle Ankle Range of Motion

Keeps the ankle moving comfortably to restore gentle motion.

What it helps: Eases motion back into the ankle so it stays supple, within the limits your surgeon sets.

1. Seated, slowly point your foot down and bring it back toward neutral.
2. Gently move the foot side to side.

Tips:

• Stay within a comfortable, pain-free range — avoid forcing the foot.
• Your care team can guide how much ankle motion is right for your recovery.

Commonly done as 2-3 sets of 10, as directed.

Ankle Alphabet

Traces the alphabet with the foot to restore ankle motion in every direction.

What it helps: Moves the ankle through its full range while you trace each letter — restoring motion in every direction.

1. With the leg supported, slowly "draw" each letter of the alphabet using your big toe.
2. Move from the ankle, keeping the leg still.

Tips:

• Move within a comfortable, pain-free range.

Commonly done as 1-2 sets of A–Z, a few times a day.

Theraband Dorsiflexion

Strengthens the muscles that lift the foot, using a resistance band.

What it helps: Strengthens the muscles that lift your foot, so you clear the ground cleanly and don't catch your toes.

1. Sit with your leg out and loop a band around the top of your foot, anchored in front of you.
2. Slowly pull your foot up toward you against the band.
3. Return slowly to the start.

Tips:

• Keep the motion smooth and within a comfortable range.

Commonly done as 2-3 sets of 10-15, daily.

Toe Curls

Strengthens the small muscles under the foot.

What it helps: Strengthens the small muscles under the foot that support your arch and grip the ground.

1. Seated with your foot flat, curl your toes downward as if gripping the floor.
2. Hold briefly, then relax.

Tips:

• Keep the motion gentle and controlled.

Commonly done as 2 sets of 10-15, daily.

Toe Flexion & Extension (Lesser Toes)

Keeps the smaller toes moving while the fused big toe stays protected.

What it helps: Keeps the smaller toes moving and supple while the rest of the foot is protected.

1. Curl the smaller toes downward, then straighten and spread them upward.
2. Keep the big toe still — it is fused and should not move.

Tips:

• A gentle way to keep the foot active in the early weeks.

Commonly done as 15-20 repetitions, a few times a day.

Seated Heel Slides

Encourages gentle ankle and knee motion while seated.

What it helps: A supported way to ease motion back into the knee and ankle while you stay comfortably seated.

1. Sit with your foot flat on the floor.
2. Slide your heel back toward the chair, bending the knee and ankle.
3. Slide it forward again.

Tips:

• Keep it slow and within comfort.

Commonly done as 2-3 sets of 10, daily.

Seated Knee Extensions

Keeps the thigh strong while you stay off the foot.

What it helps: Keeps the thigh strong and the knee straightening well while you stay off your feet.

1. Sit in a chair with your foot supported.
2. Straighten your knee, lifting the lower leg.
3. Lower slowly.

Tips:

• Keep the movement at the knee, not the ankle.

Commonly done as 2-3 sets of 10, once or twice a day.

Hip Extension

Strengthens the back of the hip and buttock without loading the ankle.

What it helps: Strengthens the glutes and the muscles behind the hip that power each step — built while staying off the foot.

1. Lie on your stomach, or stand holding a counter for support.
2. Keeping your leg straight, lift it gently backward.
3. Lower slowly.

Tips:

• Move from the hip and avoid arching your low back.

Commonly done as 2-3 sets of 10, daily.

Core Strengthening

Supports posture and overall stability.

What it helps: Builds the core that holds your trunk steady, supporting your posture, your back, and everything you do on your feet.

1. Perform gentle core exercises as directed.

Commonly done a few times a week.

Standing Weight Shifts

Builds comfort bearing weight evenly through both feet.

What it helps: Gently retrains you to load each leg evenly and confidently — the first step back to steady, balanced walking.

1. Stand holding a counter, feet hip-width apart.
2. Slowly shift your weight from one foot to the other.
3. Keep the movement smooth and controlled.

Tips:

• Let comfort guide how much weight you shift onto the surgical side.

Commonly done as 2-3 sets of 10, daily.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Theraband Inversion

Strengthens the muscles that turn the foot inward, balancing the ankle.

What it helps: Strengthens the muscles that turn the foot inward, helping balance and steady the ankle.

1. Sit with a band looped around the inside of your foot, anchored to the opposite side.
2. Slowly turn your foot inward against the band.
3. Return slowly.

Tips:

• Keep the motion controlled and within comfort.

Commonly done as 2-3 sets of 10-15, daily.

Theraband Plantarflexion

Gently rebuilds the downward push of the ankle using a resistance band.

What it helps: Rebuilds the downward push of the ankle that powers walking and stairs.

1. Sit with your leg out in front and loop a resistance band around the ball of your foot.
2. Hold the ends and slowly press your foot downward against the band, like pressing a gas pedal.
3. Return slowly to the start.

Tips:

• Keep the motion smooth and within a comfortable, pain-free range.

Commonly done as 2-3 sets of 10-15, daily.

Seated Heel Raises

Gently activates the calf while seated and protected.

What it helps: Gently activates the calf while seated and protected — an early step toward push-off strength.

1. Sit with your feet flat on the floor.
2. Lift your heels, rising onto the balls of your feet.
3. Lower slowly.

Tips:

• Keep the weight comfortable across the foot.

Commonly done as 2 sets of 10-15, daily.

Towel Scrunches

Re-wakes the small muscles of the foot using a towel.

What it helps: Re-wakes the small muscles under the foot that support your arch and help you grip and balance.

1. Sit with your foot flat on a towel on the floor.
2. Use your toes to scrunch and pull the towel toward you.
3. Relax and repeat.

Tips:

• A light, controlled effort is all you need.

Commonly done as 2 sets of 10, daily.

Standing Balance (Double-Leg)

Builds steadiness standing evenly on both feet.

What it helps: Builds steady, even standing on both feet — the foundation for confident movement.

1. Stand with feet hip-width apart near a counter for support.
2. Hold a steady, balanced position.
3. Progress by lightly closing your eyes or standing on a softer surface as able.

Tips:

• Keep support within reach.

Commonly done as 3 sets of 20–30 sec hold, daily.

Mini Squats

Builds leg strength through a comfortable range.

What it helps: Builds hip and leg strength through a comfortable range, so everyday moves — sitting, standing, bending — take less out of your joints.

1. Stand holding a counter.
2. Bend your knees a small amount, keeping them behind your toes.
3. Return to standing.

Commonly done as 2-3 sets of 10, once or twice a day.

Stationary Bike

Builds motion and endurance with low impact.

What it helps: Keeps the joints moving and nourished while you build endurance — all with no pounding. One of the gentlest ways to stay active when a joint is sore.

1. Set the seat so pedaling is comfortable.
2. Pedal at an easy pace.
3. Increase your time gradually.

Commonly done as directed.

Theraband Inversion

Strengthens the muscles that turn the foot inward, balancing the ankle.

What it helps: Strengthens the muscles that turn the foot inward, helping balance and steady the ankle.

1. Sit with a band looped around the inside of your foot, anchored to the opposite side.
2. Slowly turn your foot inward against the band.
3. Return slowly.

Tips:

• Keep the motion controlled and within comfort.

Commonly done as 2-3 sets of 10-15, daily.

Double-Leg Heel Raises

Begins rebuilding calf strength using both legs together.

What it helps: Begins rebuilding calf strength using both legs together to share the load.

1. Stand holding a counter for support.
2. Rise up onto the balls of both feet.
3. Lower slowly with control.

Tips:

• Share the load across both feet at first.

Commonly done as 2-3 sets of 10-15, daily.

Single-Leg Weight Shifts

Builds confidence putting weight through the new ankle joint.

What it helps: Builds confidence loading one leg fully — an early step toward steady single-leg standing and walking.

1. Stand holding a counter for support, feet hip-width apart.
2. Slowly shift your weight toward the surgical side, then back to center.
3. Progress to holding more weight on that side as comfort allows.

Tips:

• Keep support nearby and let comfort guide how much weight you shift.

Commonly done as 2-3 sets of 10, daily.

Calf Stretch

Keeps the calf and Achilles flexible, easing tension on the arch.

What it helps: Keeps the calf and Achilles supple, easing tension through the ankle and the arch of the foot.

1. Stand facing a wall, hands on the wall, surgical leg back.
2. Keep the back knee straight and heel down, and lean forward until you feel a stretch in the calf.
3. Then bend the back knee slightly to stretch a little lower.

Tips:

• Keep the stretch gentle and steady — no bouncing.

Commonly done as 3 sets of 20–30 sec hold, daily.

Resistance Band Ankle Strengthening

Strengthens the ankle in all directions with a band.

What it helps: Strengthens the ankle in every direction with a band, building the all-around support that steadies each step.

1. Loop a resistance band around your foot.
2. Push down, pull up, and turn the foot in and out against the band.

Tips:

• Move slowly and keep the motion controlled.

Commonly done as 2-3 sets of 10-15, daily.

Progressive Walking Program

Keep building your walking distance and pace.

What it helps: Keep building your walking distance and pace — steady gains in endurance and confidence on your feet.

Commonly done daily.

Step-Ups

Builds strength for stairs and daily activity.

What it helps: Builds the leg and hip strength — and the control — for stairs, curbs, and everyday activity.

1. Step up onto a low step with your operative leg.
2. Step back down with control.

Tips:

• Hold a rail for balance.

Commonly done as 2-3 sets of 10, once or twice a day.

Sit-to-Stand

Builds the strength and confidence to rise from a chair.

What it helps: Trains the exact strength you use to rise from a chair, a toilet, or a car. Stronger here means more independence and less of a struggle on tough days.

1. Sit at the edge of a sturdy chair.
2. Lean slightly forward and stand up.
3. Lower yourself back down with control.

Tips:

• Use your arms for support as needed.

Commonly done as 2-3 sets of 8-10, once or twice a day.

Swimming

Low-impact, full-body conditioning.

What it helps: Full-body conditioning with the water carrying your weight, so your muscles work hard with almost no load on the joints.

Commonly done as able.

Single-Leg Heel Raises

A key strength milestone — calf raises on the surgical leg alone.

What it helps: Calf strength on one leg — a milestone that means the ankle can power a normal step on its own.

1. Stand holding a counter for balance.
2. Rise onto the ball of your surgical foot only.
3. Lower slowly.

Tips:

• Build repetitions gradually — this strength often returns slowly.

Commonly done as 2-3 sets of 8-12, daily.

Calf Strengthening Program

Ongoing, progressive loading to rebuild full calf strength and endurance.

What it helps: Progressively rebuilds the calf strength that powers every push-off and step.

1. Continue heel-raise variations, adding resistance and repetitions over time.
2. Include slow, controlled lowering.

Tips:

• Symmetry with the other side is the long-term goal.

Commonly done several times a week.

Single-Leg Balance on Foam

Challenges ankle stability on a soft, unstable surface.

What it helps: Challenges your ankle and leg to stay steady on a soft surface, sharpening the reflexes that keep you sure-footed.

1. Stand on a foam pad or cushion near a counter for support.
2. Lift the other foot and balance on the surgical leg.
3. Hold with control, then rest.

Tips:

• Keep support nearby — build up your time as balance improves.

Commonly done as 3 sets, several times a week.

Balance Board Training

Challenges the ankle's steadiness on a gently unstable surface.

What it helps: Challenges the ankle to react and steady itself on an unstable surface — the control that helps prevent rolls and falls.

1. Stand near a counter for support and place both feet on a balance or wobble board.
2. Slowly tilt the board forward, back, and side to side under control.
3. Progress toward more movement as your steadiness improves.

Tips:

• Keep a hand or fingertip on support until you feel secure.

Commonly done as 2-3 sets, several times a week.

Walking Program

Short, frequent walks build endurance and confidence.

What it helps: Comfortable, frequent walking keeps the joints loose, builds your stamina, and rebuilds confidence on your feet. Little and often beats long and tiring.

1. Take short walks at a comfortable pace.
2. Increase your distance gradually as you feel able.

Tips:

• Use your assistive device as directed.

Commonly done throughout the day.

Cycling

Low-impact endurance and motion.

What it helps: Low-impact endurance that keeps the joints moving smoothly while you build fitness — easy on the body, good for the long run.

Commonly done as able.

Strength Training

Maintains and builds long-term strength.

What it helps: Builds and maintains long-term strength to keep you active, resilient, and independent.

Commonly done a few times a week.

Hiking

Walking on trails and varied terrain as endurance and confidence return.

What it helps: Walking varied terrain builds endurance, balance, and confidence as you return to the outdoors.

1. Start with short, flat trails.
2. Build distance and add gentle inclines as comfort allows.

Tips:

• Supportive footwear and trekking poles can help early on.

Commonly done as cleared.

Return to Recreational Activities

Easing back into the hobbies and activities you enjoy.

What it helps: Easing back into the sports and activities you love, at a pace your body is ready for — the reward for the strength you've built.

1. Reintroduce low-impact activities you enjoy, as cleared by your surgeon.
2. Start with shorter sessions and build duration and intensity gradually.
3. Listen to your body and progress steadily.

Tips:

• Ramp up gradually — avoid sudden big efforts.
• A flare after activity means ease back, not stop entirely.

Commonly done as tolerated.