Tibialis Posterior Tendon Reconstruction

The tibialis posterior tendon runs down the inside of the ankle and attaches to the middle of the foot. The tendon functions to maintain the height of the arch of the foot and to pull the foot inwards (inversion). Once the tendon becomes dysfunctional, the height of the arch drops and the heel turns outward (valgus). This often results in pain and swelling on the inside of the ankle and with time on the outside of the foot as well. Left untreated, the joints of the hindfoot (subtalar, talonavicular and calcaneo-cuboid joints) become painful and arthritic.

Tibialis posterior tendon reconstruction surgery has a number of steps. These include:

• Nerve block, general anaesthetic, intravenous antibiotics
• Lengthening of the tendo-Achilles (when indicated)
• Realignment of the heel bone (calcaneus) fixed with screw
• Insertion of screw into outside of foot (sinus tarsi screw) – this helps to restore alignment of hindfoot and midfoot
• Check x-rays
• Repair of tibialis posterior tendon with neighbouring (flexor digitorum longus) tendon
• Stabilisation of midfoot (talo-navicular joint capsule)
• Closure of wound with stitches/sutures
• Back slab plaster

All surgical procedures carry some risk. The risk of complications with tibialis posterior tendon surgery are low. Some of the risks include:

• Infection
• Problems with wound healing
• Tendon rupture
• Periprosthetic fracture
• Osteotomy non-union
• Recurrence of flat foot deformity
• Nerve injury causing numbness, tingling and/or pins and needles – this is most common on outside of foot
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain
• Irritation from plate and screws which may necessitate removal of hardware

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 4 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 2 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot, commence rehabilitation
• 2-6 weeks: regular physiotherapy to increase range of motion
• 6 weeks to 3 months: work on swelling reduction, scar massage and mobility. Progress weight bearing
• Full recovery 6-9 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.