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Tendon transfers in the ankle

A tendon transfer is a surgical procedure which replaces a damaged tendon with a healthy tendon from another area of the body. This allows an increase in function and movement at the joint and helps to reduce any pain that you experienced previously. Tendon transfers may be necessary for a number of reasons including:
  • Flat feet (the tendon at the back of the back of the lower leg is diseased; posterior tibial tendon)
  • Foot drop which is from damage to the nerve which dorsiflexes the foot (pulls the foot up)
  • Diseases such as polio which can cause damage to the nerves supplying the tendons of the foot and leg
  • Following surgery if the nerve supplying a tendon has been disrupted
  • Tendon damage due to a spinal injury or disc prolapse
  • Any direct trauma causing a tendon or its supplying nerve to be ruptured
  • Fractures around the hip, lower spine and leg may also damage the nerve supplying tendons of the lower limb (sciatic nerve)
  • Tendon damage
  • Other diseases such as rheumatoid arthritis, cysts or tumours
  • Severe infection of a tendon
Physiotherapy at is necessary before and after surgery to give you the best possible chance of a successful recovery.

Physiotherapy prior to tendon transfer in the ankle

The specialist physiotherapists at will work with you to design a specific rehabilitation programme tailored to your individual needs. You may be placed on a waiting list for your surgery and so it is important to keep the affected area and surrounding joints and muscles as strong as possible to help with your recovery. Physiotherapy at this stage may include:
  • Gentle range of movement and strengthening exercises at the affected joint and/or muscle
  • Soft tissue techniques such as massage and frictions to prevent the muscle becoming tight
  • Mobilisations on the affected joint to maintain movement
  • Strengthening and range of movement activities for the opposite leg
  • Cardiovascular activities such as cycling and rowing

Symptoms after tendon transfer in the ankle

For the first ten days after your operation you will be walking using crutches and therefore only partially weight-bearing. Following surgery you may experience the following temporary symptoms which your physiotherapist at will instruct you on how best to manage. These may include:
  • Swelling
  • Pain due to the surgery
  • Temporary pins and needles or numbness if a nerve has been disrupted during surgery
  • Stiffness
  • Tightness of the muscles surrounding the area
  • A scar where the incision has been made

Physiotherapy after tendon transfer in the ankle

Your physiotherapist at will not only help you to reduce the temporary symptoms but also increase the strength and function of the affected joint and muscles allowing you to maximise your potential following the surgery.

Weeks 1-2

Immediately following tendon transfer surgery your foot will be placed in an aircast boot for the first 6 weeks which will protect the area. Physiotherapy at this stage will concentrate on reducing the symptoms of the surgery and teaching you how to partially weight-bear using crutches. Your physiotherapy programme may include:
  • Elevation and gentle foot and ankle exercises to reduce swelling
  • Cryotherapy (ice) to reduce swelling
  • Pain control modalities
  • Gait (walking) re-education using crutches
  • Electrotherapy techniques such as ultrasound to facilitate healing of the tendon
  • Strengthening exercises for muscles surrounding the affected area
  • Range of movement exercises for the affected joints
  • Upper limb activity such as arm cycling

Weeks 3-6

Your foot will still be in an aircast boot but your physiotherapist at may allow you to begin putting more weight on the affected leg. You may be able to do slightly more now if the temporary symptoms are reducing and your programme will focus on helping you to return to work and/or hobbies. Physiotherapy may now include:
  • Progression of range of movement and strengthening exercises on both legs
  • Continuing cryotherapy and elevation exercises to reduce swelling
  • Specific exercises relating to your job or hobbies
  • Soft tissue mobilisations to increase range of movement at the joint
  • Deeper massage on tight muscles
  • Gentle frictions on the scar to increase its mobility
  • Continuing ultrasound to facilitate healing of the tendon

Weeks 6 onwards

By now the aircast boot should be removed and you may be advised by your physiotherapist to fully weight-bear (without crutches). If you are in a sedentary job you should now be able to return to work but it may take slightly longer for more active occupations. Your physiotherapist at will advise you on how to best manage at work and ways to pace yourself to limit the chance of any reoccurring symptoms. Your physiotherapy programme will now be more functional and specific to your hobbies and job. It may focus on:
  • Regaining the strength and movement that you originally had before the injury
  • Returning to your usual cardiovascular fitness by rowing, treadmill activities, swimming and cycling
  • Balance and proprioception (joint awareness) exercises
  • Gait re-education indoors and outdoors on a variety of surfaces
  • Maintaining upper limb strength, movement and function


Tendon transfer in the ankle is a surgical procedure which aims to restore movement, strength and function by using a healthy tendon from another area of the body to replace a damaged or diseased tendon. This type of surgery is generally very effective if a comprehensive rehabilitation programme is followed. At, our specialist physiotherapists will design an individualised programme to help you before and after surgery. By adhering to your physiotherapy programme, it will allow the best chance of a successful recovery without any complications. Please call on 0330 088 7800 to book an appointment today!

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