Foot tendon surgery, including repairs to structures like the Achilles, posterior tibial, or peroneal tendons, is a common procedure intended to restore stability and function to the foot and ankle. Recovery is a phased process requiring patience and adherence to medical guidance. This article details the expectations for recovery, from preparations before the procedure to the eventual return to full activity. Understanding this journey helps manage the physical and logistical demands of healing and sets realistic expectations.
Preparing for the Surgery
Preparation for foot tendon surgery begins well before the procedure to ensure a smooth experience and minimize complications. Your surgeon will require pre-operative clearance, which may involve blood work or imaging tests to confirm your health status. Discuss all medications with your doctor, as anti-inflammatory drugs (NSAIDs) and blood thinners must often be stopped seven to ten days prior to surgery to reduce the risk of excessive bleeding.
The day before, adhere to strict fasting instructions, meaning no eating or drinking anything, including chewing gum, after midnight. Arrange for transportation home and secure a responsible adult to stay with you for the first 24 hours, as you will not be able to drive. Logistical planning includes setting up a comfortable recovery area at home with everything easily accessible, since mobility will be highly restricted initially. You may also be instructed to use an antiseptic wash for several days before the surgery to reduce bacteria near the surgical site.
The Procedure and Immediate Aftermath
On the day of surgery, you will check in and be prepared by the nursing team, including changing into a gown and having your vitals monitored. Anesthesia will be administered, often involving general anesthesia for sleep combined with a regional nerve block. The regional block is a local injection that temporarily numbs the surgical area, providing significant pain relief that can last anywhere from 12 to 30 hours post-procedure.
The surgical team performs the repair, involving a controlled incision, reattachment or reconstruction of the damaged tendon, and closure of the wound with sutures. A tourniquet is inflated around the upper leg during the operation to manage bleeding. Following the repair, the foot is secured in a padded splint or half-cast to protect the tendon and maintain its proper position for initial healing.
After waking up, you will be moved to a recovery area for monitoring before discharge. Immediate post-operative care focuses on preemptive pain management, especially as the nerve block wears off. It is recommended to take the prescribed pain medication as soon as you get home, before the pain becomes intense, and to continue taking it on a schedule for the first 48 hours. You may notice some blood seepage or staining on the bandage, which is not a concern unless the drainage is excessive or soaks through the dressing.
Navigating the Non-Weight-Bearing Phase
The non-weight-bearing (NWB) phase is the first and most taxing period of recovery, as putting any pressure on the operated foot can compromise the tendon repair. This restriction means no weight whatsoever, not even standing briefly, and typically lasts anywhere from two to eight weeks, depending on the specific tendon and surgery complexity. You must rely completely on mobility aids such as crutches, a walker, or a knee scooter to move around your home.
Strict elevation is the most effective way to control swelling and pain in the initial weeks. Keep the foot elevated above the level of your heart for most of the day, ideally for 23 hours daily during the first two weeks. When sitting, the foot should be positioned higher than your hip, and you should limit the time the foot is in a dependent position (hanging down) to no more than ten minutes at a time. Icing reduces inflammation; apply it over the cast or dressing for 20 to 30 minutes every few hours, never directly on the skin.
Maintaining the integrity of the cast or splint is paramount; it must be kept clean and completely dry at all times. Showers require specific precautions, such as using a plastic cast protector or securing a trash bag with duct tape to prevent water from weakening the plaster or soaking the incision. During this period, watch for signs of complications, such as excessive warmth, unusual pain, or significant swelling in the calf, which could indicate a blood clot and require immediate medical attention. Breakthrough pain should be managed by consistently taking oral pain medications and utilizing elevation and icing, as prescribed.
Rehabilitation and Return to Full Activity
The transition from the immobilization phase to active recovery begins when the surgeon confirms sufficient initial tendon healing, often around two to six weeks post-surgery. The cast or splint is typically replaced with a removable protective boot, and physical therapy (PT) usually begins. PT is a controlled process focused on restoring joint mobility lost during the non-weight-bearing period.
Your therapist will guide you through exercises to gradually increase your range of motion, followed by strengthening activities to rebuild muscle mass in your foot, ankle, and lower leg. The progression of weight-bearing is slow and deliberate, moving from partial weight on the boot to full weight-bearing, a process that takes several weeks. Consistency in attending therapy sessions is important to fully regain strength, flexibility, and balance.
A realistic timeline for returning to daily activities depends on the specific procedure and individual healing rate. Driving the operated foot is unsafe for approximately six to eight weeks if it is the right foot, but may be possible sooner for the left foot if driving an automatic vehicle. Returning to light exercise usually occurs around six to eight weeks. High-impact activities or sports typically require a minimum of twelve weeks to ensure the repaired tendon is robust enough to handle the stress. Long-term prognosis is excellent with full compliance to the rehabilitation protocol, though some residual swelling may persist for several months.