Posterior Tibial Tendon Surgery with Gastroc Recession

Hi Dr Blake
     I am interested in your advice...I was a very active runner until I began having lots of issues with my posterior tibial tendon and eventually, after about a year of non-surgical treatment, I was diagnosed with a navicular accessory bone.  

     I had it removed 5 months ago, along with a gastroc recession.
Dr Blake's comment: 
     The restrengthening progress of surgical procedures to arguably the 2 most important muscle/tendons in your foot and ankle can be a 1 to 2 year progress. That does not mean it will take you that long to get back most of your power within a year. Typically, 30% improvement is seen by 3 months post surgery. The 3 to 9 month period is slow with gradually improvements up to 60-70%. Then, the 9-15 month part of the rehab is where the true power comes back as the internal scar tissue is finished it's long course of remodeling and thinning out. This, of course, is predated on a physical therapist who knows how to rehab this successfully, and you patiently go through the Phases of Rehabilitation correctly---Immobilization, Restrengthening, and Return to Activity. 

 My question is about how long it should take to recover?
Dr Blake's comment: So, at 5 months, you should be out on any immobilization devices like removable casts, you should be in orthotic devices and taping your arch daily, you should be increasing your walking, and perhaps started on a Walk/Run Program (although that can take up to 9 months to start). The restrengthening should be well underway with toe raises, posterior tibial theraband work, single leg balancing, and core strength workouts. As much biking, elliptical, and swimming the better as long as nothing causes limping. Read my post on "Good Pain vs Bad Pain" and do not drift into the Bad pain that often. Recovery is always a Bell Shape Curve, with some faster than others. There are so many variables at play. However, monthly you should be progressing, and keeping that 0-2 pain level Painfree environment while you get stronger. July 2013 should have more time on the bike, more toe raises, 5 more reps of theraband, easier time at doing the Single Leg Balancing, etc. than June was. You are in a time of plateaus. 3 to 9 months post surgery can go slow. With each 2 week or month plateau, it is up to the doc and PT to decide if normal, or if changes in your program are necessary. 


 I saw the surgeon at 4 months and he was very vague,and while I can do a bit more than I could Prior to surgery (cycling, some elliptical, bit of walking) it still gets quite sore.
Dr Blake's comment: To really see where you are at, you need to stay in the 0-2 pain level Good Pain Side of Rehab on a day to day basis. That is really where you are at. Find what limitations you have in attempting to maintain this level, which honors your tissue's ability to take stress, and write those down. It will take you 2-3 weeks to get a feel of really where you are at and then you can compare July accurately with August, and August with September, etc. Remember pain leads to swelling and scar tissue, and we need to reduce build up daily.

 I am doing several strengthening exercises and calf stretches, and back off when the pain gets worse but in the last few weeks I don’t feel I’ve made that much progress. Is this normal and when do you think I should expect to be able to start running?
Dr Blake's comment: When can you run? The answer is typically easy and that is when you can walk for 30 minutes at a normal pace without increasing in pain above 0-2, then you can be started on a 30 minute Walk Run Program. I have that program in this blog. 30 minute Walk Run Program has 10 levels that you progress through slowly and carefully, and you are only starting with 3 minutes running. I hope this all makes sense. Listen to your body. If you do not have help from a PT, get some if possible to give you guidelines on how to progress over the next 4-6 months carefully. Good Luck!! Rich
Ciara (name changed due to Witness Protection)