Peroneal Tendon Debridement / Repair PT Protocol

Precautions

• Non-weight-bearing for 2 weeks.
• No active ankle eversion for 6 weeks — protects the superior peroneal retinaculum, which holds the tendons in their groove.
• No cutting sports or strenuous running for 4 months.
• Surgery removes scar tissue and/or repairs the peroneal tendons, sometimes with groove-deepening; active PT participation is key to a good outcome.

Weeks 0–2 (Immediately After Surgery)

• Ankle in a well-padded splint/soft cast; ice, elevate, rest, and take pain medication as directed.
• No weight bearing on the operative ankle.

~2 Weeks (First Post-Op Visit)

• Soft cast removed and sutures out (if the incision is healed); placed in a boot with the ankle in neutral.
• Progressive weight bearing in the boot only; continue crutches/walker/scooter as needed to advance.
• Out of the boot periodically for seated active dorsi/plantarflexion (up/down) to prevent adhesions. No active eversion.

4 Weeks

• Begin physical therapy focused on regaining motion — still no active eversion.
• Full weight bearing now allowed in the boot; discontinue the assistive device (may keep for long distances).
• Begin passive/active inversion and passive eversion under the therapist; modalities as needed.

6 Weeks

• Wean out of the boot; active eversion now permitted under therapist guidance.
• Continue ROM (goal: full range in all planes by 12 weeks); stationary bike with resistance. Avoid uneven/rocky terrain.

8 Weeks

• Advance peroneal strengthening as tolerated; begin light jogging, squatting, and weight-lifting.
• Balance and proprioception training; increase activity as tolerated.

3 Months

• Begin a walk/jog interval program progressing toward running once full active ROM and strength are achieved (cleared by Dr. Allred).
• Plyometric drills front-to-back progressing to lateral; sport-specific training if pain-free. Uneven/rocky terrain now OK.

4 Months

• Introduce cutting activities; progressive closed-chain program with proprioceptive challenges, agility, and endurance.

References

• Rehabilitation Protocol for Peroneal Tendon Repair. Massachusetts General Hospital.
• Physical Therapy Guidelines for Peroneal Tendon Repair. Massachusetts General Hospital (Foot & Ankle).