Mark Blackney & Terence Chin
The Tibialis Posterior (TP) tendon is one of the major stabilizing structures in the foot. It runs behind the bump on the inside of the ankle (the medial malleolus) and across the instep where it inserts. The main functions of the tendon are to support the arch and keep the foot turned inwards when walking. The TP can become damaged by wear and tear or acute trauma. In the initial stages pain is felt along the length of the tendon (behind the medial malleolus), but as the problem worsens deformity becomes apparent and the foot flattens and turns outwards.
Pain may develop on the outside of the ankle and if the deformity continues to worsen over time the joints in the hind foot become affected and can become arthritic. The surgical treatment is complex and depends on the location and severity of damage.
Non operative treatment
In the early or mild stages of TP tendon dysfunction simple painkillers, orthotics, physiotherapy and occasionally steroid injections are used. Sometimes this is not sufficient and the problem progresses or the foot becomes arthritic. In this case surgery can help.
In most cases the tendon itself is repaired and needs to be strengthened by using another tendon, flexor digitorum longus. This tendon lies alongside tibialis posterior at the ankle and bends the small joints of the toes. Other tendons help to carry out this function and so the tendon is not really missed when it is used.
To improve the biomechanics of the tendon transfer the heel bone is moved towards the inside of the foot (calcaneal osteotomy), held with one screw and a plug is inserted into the subtalar joint to support the arch. The plug and screw are generally removed in a second operation when the tendon is strong enough, about 6 months after the first operation. This is a small day case operation and recovery is swift.
In more advanced cases, up to 3 of the joints in the foot can become arthritic. These joints (subtalar, talo–navicular, and calcaneo–cuboid) are fused using bone graft taken from either the heel or the hip bone. This is known as a ‘triple fusion.’ The recovery from tendon reconstruction or fusion surgery is lengthy. You will spend 6 weeks in a cast and then undergo an intensive rehabilitation program as directed by your physiotherapist.
Risks and complications
No surgery is risk free. The risks and complications will be assessed and discussed with you. There is always a small risk of infection, blood clots and anaesthetic problems and measures are taken to reduce these. There is usually a 5–10% chance of experiencing a problem of some kind with this type of surgery. A satisfactory outcome is expected in 90% of cases.
|Hospital Stay||2 nights|
|Rest & Elevation||1 week|
|Suture Removal||2 weeks|
|Time in plaster||6 weeks|
|Crutches required||6 weeks|
|Foot swelling||3 months|
|Implant removal||6 months|
These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances. Please contact Mr Blackney′s rooms on (03) 9417 0762 or Mr Chin′s rooms on (03) 9928 6450 if you require further information.