Posterior tibial tendon reconstruction
Posterior tibial tendon reconstruction surgery is used to correct the dysfunction of the posterior tibial tendon, the main tendon that supports the arch of the foot. Posterior tibial tendon dysfunction is a condition resulting from overuse or injury to the tendon. The tendon connects the calf muscle in your lower leg to the inner part of your foot. When the tendon becomes inflamed or torn, it no longer can support the arch of your foot, which collapses as a result. Posterior tibial tendon dysfunction can be very painful and debilitating and often requires surgery for the more severe cases.
Depending on the severity of posterior tibial tendon dysfunction, nonsurgical treatment can relieve all or most of the painful symptoms. Treatment includes:
- Rest and immobilization – Decreasing or completely stopping any activities that aggravate the inflamed or torn tendon can help the healing process tremendously. Sometimes bed rest is suggested for a few days prior to other activity changes.
- Ice therapy – Placing an ice pack on the foot and ankle for 20 minutes at a time can alleviate pain, swelling and inflammation.
- Anti-inflammatory medication – Aspirin, ibuprofen and naproxen are common over-the-counter anti-inflammatory medications used to control pain and inflammation.
- Orthopaedic footwear – A leg brace or orthopaedic shoe may be recommended by your doctor to reduce pressure and impact on the affected tendon. Protecting the tendon from further damage use can allow it to heal properly.
- Cortisone injections – Cortisone is a steroidal medication that can be injected directly into the tendon to reduce swelling, inflammation and pain.
- Physical therapy – A physical therapist can train you on new techniques and ways to perform activities than can reduce impact and damage to the tendon. Physical therapy is often combined with one or more other nonsurgical treatments for posterior tibial tendon dysfunction.
Surgery for posterior tibial tendon dysfunction is performed only if nonsurgical treatments do not stop the pain after six months. There are a variety of surgeries used for posterior tibial tendon reconstruction. Each surgery depends on the location and severity of the damage to the tendon. Types of reconstruction surgery include:
- Lengthening of the Achilles tendon – Otherwise known as gastrocnemius recession, this procedure is used to lengthen the calf muscles in the leg. This surgery treats flatfoot and prevents it from returning in the future, and is often combined with other types of surgery to correct posterior tibial tendon dysfunction.
- Cleaning the tendon – Also known as tenosynovectomy, this procedure is used in the earlier stages of posterior tibial tendon dysfunction. It is performed before the arch collapses and while the tendon is only mildly affected. The inflamed tissue is cleaned away and removed from the remaining healthy tendon.
- Tendon transfer – This procedure is performed to correct flatfoot and reform the lost arch in the foot. The diseased tendon is removed and replaced by a tendon from another area of the foot. If the tendon is only partially damaged, the inflamed part is cleaned and removed and then attached to a new tendon.
- Cutting and shifting bones – Also called an osteotomy, this surgery consists of cutting and reconstructing bones in the foot to reconstruct the arch. The heel bone and the midfoot are often reshaped to achieve this desired result. A bone graft may be used to fuse the bones or to lengthen the outside of the foot. Temporary instrumentation, such as screws and plates, also can be used to hold the bones together while they heal.
- Fusion – In some cases that usually involve arthritis, the flatfoot is stiff and is not flexible enough to be treated with tendon transfer or bone-cutting procedures. Fusion of the joints in the back of the foot can realign the foot, remove any arthritis and make the shape of the foot normal again. During the procedure, all the cartilage is removed from the joint and replaced with bone graft material to fuse the joints together. Fusing of the joint creates one solid bone to eliminate any pain from the previously moving joint. Instrumentation can be used to further secure the bones while they fuse together.
The multidisciplinary team of foot and ankle experts at Northwell Health Orthopaedic Institute performs posterior tibial tendon reconstruction surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the foot and ankle.