Question
QUESTION: I am about 20 weeks post ptt and spring ligament repair, tendon tansfer, cotton and calcaneal osteotomy and achilese tendon lengthening.  After being NWB for about 9 weeks, I was put in an aircast. Any attempt to manually move my toes resulted in a great deal of pain so I had PT to increase the range of motion in my foot. Range of motion improved greatly after four or five weeks of PT.  Directions from my surgeon were explicit not to do any strengthening activities. At 9 weeks post op, I graduated to fwb only while wearing the boot.  At about 16 weeks post op, I was given clearance to wear shoes with an ASO on my surgical foot.  I just started to wear shoes without an aso at 20 weeks post op.

Last week, I had the calcaneal osteotomy screws removed due to pain when walking for any extended period of time. I have almost no pain from the hardware removal at this point and will have stitches removed in another week.

When I read posts from people with very similar surgeries, there is so much variation in the post op protocol.  

Is there a "typical" protocol for PT for strengthening the muscles after flat foot reconstruction?

I am working with a local CPED in shoe selection/modification.  

Could just walking on a properly alligned foot strengthen the muscles of the foot adequately without the need for additional PT?

ANSWER: This Chicago, South Loop & Elmhurst Orthopedic Podiatrist of AnklenfootCenters.com says.......

Dear Stacy

Don't listen to all the noise out there. Every person & surgery is different!
If you are not athletic-then just an appropriate shoe selection may be enough.
If you wish to participate in athletics-then  strengthening will be required-post multiple foot surgeries.
This strengthening can be done on your own-in a club or at home-if you have perseverance.Physical therapy is good for stiffness and weakness-which you are not complaining of. If you can train on your own-go for it! Be careful of overzealous health club trainers.
Slowly continue to increase your activities and let your body tell you how you are doing.
Any kind of get up on your toes exercises, one one foot, are a good indicator of strength.
Try to increase reps and hold time-unless contra-indicated by your  doctor
Expect minor soreness and weakness that should improve over 2-3 week periods.
Do not over-train. Use ice generously.Wear your brace.
Hope This Helps!
and
Good Luck!

The podiatrists of AnkleNFootCenters.com are specialists in foot& ankle fractures.
We are Podiatrists in Chicago & Elmhurst
Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.  I am not athletic.  I just want to be able to do normal day to day activities without my pre surgery pain.  The good news is that so far everything is going according to plan. My ankle no longer looks as if it is caving in when I stand.  My foot does not look like a pancake either.  When I walk, I am not walking on the outside of the foot so I guess that the foot was NOT over corrected.  My surgeon said that the arch height is not really important.  He fees that the goal of surgery is to allign the foot so that pressure is taken off of the repaired posterior tibial tendon and spring ligament without over correcting the foot. I guess that after going through such an extensive surgery with a long and difficult recovery, I am quite protective of my "new" foot.

Thanks again for your response

Answer
Answer:   This Chicago, South Loop & Elmhurst Orthopedic Podiatrist of AnklenfootCenters.com says.......

Dear Stacy

Following PTTD/flatfoot surgery- the MOST important aspect to your full recovery is to keep your weight to your age and height minimum!  
That said-practice getting up on your toes exercises, one foot up.Hold on to something for balance
Try to increase reps and hold time-unless contra-indicated by your  doctor.
Before and after do 3 minutes  of gentle ankle rotations-both directions.
Expect minor soreness and weakness that should improve over 2-3 week periods.Don't forget ice it you overdo it. Try walks  for 45 minutes-that will be aerobically beneficial and not too much stress on your foot-Take your time to work up to that time. These simple exercises would be a good start.
Happy New Year!!!
Hope This Helps!
and
Good Luck Again!

The podiatrists of AnkleNFootCenters.com are specialists in foot& ankle surgeries.
We are Podiatrists in Chicago & Elmhurst
Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661
AnkleNFoot.com
Runnersdoc.com
BabyFootDoc.com

DISCLAIMER:
This information is offered as free advice and as general information. It may not be applicable to the specific questioner and his/her problem.  It is not based on actual knowledge of the questioner or his/her medical history and it cannot and should not be relied upon as definitive medical opinion or advice.  Reliable medical opinion and advice can only be obtained through hands-on physical contact and exam of the patient to establish an accurate diagnosis and treatment plan.  No doctor/patient relationship is created or established here and may not be inferred through answers on this site.  The questioner and other readers must consult his/her own doctor before proceeding or implementing any suggestions contained within this document and answers on this site.  The questioner is only to act upon his/her own doctor抯 orders and recommendations. By reading this posting which follows, the reader fully understands and confirms that he/she holds harmless this writer. If this is not fully agreeable to you, the reader, and/or you have not attained the age of 18 years, you hereby are advised to read no further.