Case Study: Jackson
Rehabilitation After Calcaneal Tendon Surgery — From Hooked Toes and Partial Weight-Bearing to 4–5 Mile Walks and Discharged by His Vet
Patient Summary
Presentation and Background
Jackson’s story began in October 2023 when his owners noticed abnormal posture in his right hindlimb. Veterinary examination identified calcaneal tendinopathy — a condition affecting the tendons that run behind the hock — and the leg was managed conservatively with rest. In May 2024 the problem recurred. Imaging confirmed tendinopathy with the superficial digital flexor tendon remaining intact but with bony changes at the point where the tendon attaches to the heel bone. In September 2024 surgery was performed, placing a screw to stabilise the right hock and protect the tendon during healing. Jackson wore a custom orthotic brace throughout the nine weeks the screw was in place.
When the screw was removed, the hyperflexion that had been present before surgery had resolved — a positive surgical outcome. However, Jackson’s standing posture remained abnormal. He was holding the right hindlimb to the side, bearing only partial weight, and his toes were curling under rather than placing flat. His vet referred him for physiotherapy in January 2025 with the goal of restoring normal limb posture and function. The injury was complex: the tendon itself, the soft tissues around the hock, and the muscles of the entire hindlimb had all been affected by months of abnormal loading.
During the course of rehabilitation, the left hindlimb also developed calcaneal tendinopathy — a known risk in these cases, where the sound leg compensates heavily for a long period — requiring the programme to adapt and address both limbs simultaneously.
Rehabilitation Programme
When Jackson arrived for his first session he was consistently placing his right hindlimb laterally with partial weight-bearing, his toes were hooked under rather than flat, and range of motion in the hock and toe joints was severely restricted. Significant muscle wasting was present throughout the right hindlimb, with the right thigh measuring 3cm smaller than the left. His back muscles were also working hard to compensate. Rehabilitation was structured across four phases, working in close communication with his veterinary surgeon throughout.
The early priority was restoring movement in the toes and hock, which had become stiff and restricted during the months of immobilisation. Therapeutic laser was applied to the calcaneal tendon and tarsal joint at every session to support tissue healing and reduce discomfort. Heat was applied to the lower paw at home before each exercise session to prepare the tissues, followed by careful passive movements through each toe joint — gently working against the shortening of the tendons that was holding Jackson’s toes in a curled position. Massage addressed the significant muscle tension that had built up through his back, left thigh, and right hamstrings. Raised food bowls encouraged better hindlimb loading during mealtimes, and a low paws-up balance exercise began the process of shifting weight onto the hindlimbs in a controlled, comfortable way.
As comfort and range of motion improved, the focus shifted to rebuilding the right hindlimb musculature and retraining Jackson to place his foot correctly. Backwards stepping exercises encouraged the toes to extend rather than curl, and cavaletti pole work was introduced to improve step quality and loading through each stride. Sit-to-stand exercises, progressively performed on more challenging surfaces including a wobble cushion, targeted the right quadriceps and gluteals. Hamstring stretches were introduced carefully, as some shortening of these muscles was limiting Jackson’s ability to reach forward with the right leg. The brace continued to be worn for walks throughout this period, with time without the brace gradually extended as the tendon strengthened. A pulsed magnetic field device was used in clinic to support tissue repair in the right thigh ahead of stretching work. By May 2025, right thigh circumference had recovered to match the left, reaching equal measurements of 45cm on both sides.
In October 2025, Jackson’s owners noticed sudden near non-weight-bearing lameness on the left hindlimb. A new referral from his vet confirmed what had been a concern throughout: the left calcaneal tendon had developed tendinopathy, most likely due to the sustained compensatory load it had been carrying for over a year. Jackson was fitted with a second custom brace for the left limb, and the programme was adapted to protect and support both hindlimbs simultaneously. Ice therapy was added at home for the left tendon, and laser therapy was extended to treat both sides in clinic. Anti-inflammatory medication was commenced to assist with the acute left-sided inflammation. The right limb brace was locked at a fixed position temporarily to reduce demand on it while the left limb was managed. Exercises were modified to avoid provoking the left tendon while continuing to maintain and build the right. Communication with the vet was ongoing throughout this period to coordinate brace settings and medication.
With both tendons stabilised and brace settings matched bilaterally, Jackson’s activity built steadily. He progressed to 4–5 mile walks without setback, managing inclines and declines confidently, and enjoying off-lead time with his braces on. His vet performed a recheck and discharged him from veterinary monitoring, with no further appointments required unless concerns arose. At his most recent physiotherapy session in January 2026, stance was symmetrical with equal loading through both hindlimbs, and thigh circumference was equal bilaterally at 41cm — reflecting a proportionate reduction from his peak measurements as activity had settled into a consistent maintenance level. The calcaneal tendons were comfortable on palpation, toe joint range continued to improve, and Jackson was performing sit-to-stand exercises with good square positioning and symmetrical push-up through both hindlimbs.
The Result
Over twelve months, Jackson went from partial weight-bearing on a hooked, poorly placed right hindlimb — with significant muscle wasting, restricted joint movement, and a pattern of compensation that had already begun to affect the opposite leg — to managing long walks with inclines, off-lead running, and bilateral symmetry in both muscle mass and limb loading. When the left hindlimb developed its own tendinopathy mid-rehabilitation, the programme adapted around it rather than being derailed by it, and both tendons are now stable and comfortable.
The thigh circumference deficit of 3cm on the right side at first assessment, and the subsequent equal measurement of 45cm bilaterally by May 2025, is objective evidence of genuine muscle restoration. That symmetry was maintained through a significant setback and still present at the final session.
What Made the Difference
Three things stood out in Jackson’s recovery. Close collaboration with his vet was essential throughout — adjusting brace settings, coordinating medication decisions, and managing the transition to bilateral involvement all required ongoing communication between the physiotherapy and veterinary teams, and Jackson benefited directly from that joined-up approach. Consistent owner commitment to a complex and demanding home programme — heat therapy, passive toe movements, stretches, balance work, and careful walk management — delivered over twelve months without significant lapse, provided the foundation on which clinic sessions could build. And adaptability: when the left limb developed tendinopathy, the programme was restructured quickly to protect it without abandoning the gains made on the right. Jackson’s case is a reminder that in complex, bilateral conditions, the ability to respond to changing circumstances is just as important as the initial plan.
Jackson’s recovery shows what is possible when a dog with a difficult, bilateral tendon condition is supported by the right team, the right tools, and owners who show up every single day.