Posterior Tibial Tendon Reconstruction

Chronic degenerative tearing of the posterior tibial tendon is a common condition. If left untreated, it will progress to a painful arthritic flat foot. Non-surgical treatment often begins with fracture brace to control initial pain and swelling. The tendon dysfunction may then be treated with a permanent ankle or leg brace. If non-surgical treatment does not relieve your symptoms satisfactorily or if signs of progressive flattening are noted, surgery is recommended.

Once this tendon is torn, it is rarely repairable, and tendon transfers and bone reshaping are required. The surgery is performed on both an outpatient and inpatient basis.

What Happens Before Posterior Tibal Tendon Surgery?

You’ll be given specific instructions on how to prepare for your upcoming operation by the surgical center. The day of surgery you will receive regional anesthesia known as a popliteal nerve block by the anesthesiologist just prior to surgery. You will be placed on your stomach and a small needle is used to inject Novocain-like medication around the nerve in your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given antibiotics just before surgery to help prevent infection.

What Happens During Posterior Tibal Tendon Surgery?

During the surgery you will undergo general anesthesia. A tourniquet will be placed around your thigh. Multiple small incisions are made along the inside and outside of the ankle and foot. The tendon to the four small toes (Flexor Digitorum Longus) is cut and moved to the midfoot to replace the torn tendon. The little toe tendons remain naturally attached to the big toe tendon which maintains function. The calcaneus and midfoot bones are often reshaped and lengthened. Sometimes a fusion or an osteotomy of the midfoot is required to complete the correction. Allograft (cadaver bone) or Autograft (derived from your hip bone) may be needed to correct the alignment. A tight heel cord is lengthened through an incision on the calf.  The wounds are closed with stitches or staples.

What Happens After Posterior Tibal Tendon Surgery?

You will be permitted to leave the post-anesthesia center once your anesthesiologist is satisfied that you have recovered. During this recovery time your family member may take your prescription to the nearest pharmacy. You will be given crutches. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wear off. Remember post operative pain is much easier to control with prevention. Call the office to schedule for first follow-up appointment when you feel able.

 

Posterior Tibial Tendon Reconstruction General Recovery Timeline

This timeline is a general guideline. Your post-operative course may vary.

Elevation	23 hours / day for 10 days; swelling may last several months.
Motion	Move your toes and knee when the block resolves. This will decrease pain, swelling and improve healing. Begin ankle motion at 6 weeks.
Walking	No weight bearing until 6 weeks. Partial weight bearing may begin when bone healing is noted around.
Bathing	Keep cast dry by using a Xerosox. There are no restrictions after the cast is removed.
Dressing	A fracture brace is applied after the cast is removed. Wean off of the brace as you strengthen with physical therapy.
Pain Control	Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Motrin.
Work	Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor and sports will take over 3 months.
Driving	Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe.
	Routine Clinic Visits
2 weeks	X-Ray and exchange cast.
6 weeks	X-Ray and apply fracture brace; begin home range of motion exercises.
10 weeks	X-Ray, begin full weight bearing and start physical therapy if healed. Return to full pre-op activity gradually.
16-20 months	Return if you have pain, other concerns, or per Dr. Silverman’s instructions. Minimal feelings of discomfort may linger, your overall comfort level improves over a year.
**********	If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office.