Posterior Tibial Tendon Reconstruction
Posterior tibial tendon dysfunction, also known as acquired flatfoot, is one of the most common deformities of the foot and ankle. This issue occurs when the posterior tibial tendon is torn or degenerative, and then stretches, resulting in the flattening of the arch of the foot.This condition is progressive, and can lead to a rigid flatfoot over time.
The symptoms of flatfoot typically include pain and swelling around the foot and ankle. Patients often experience pain that becomes significantly worse during physical activities such as walking or running. Posterior tibial tendon reconstruction is a corrective surgery for the collapsed arch in the foot, with the additional goal of relieving these symptoms. This procedure may include tendon transfer, heel realignment, lateral column lengthening, and Achilles lengthening.
The Posterior Tibial Tendon Reconstruction Procedure
Posterior tibial tendon reconstruction is performed when nonsurgical treatments, such as anti-inflammatory medications, physical therapy and bracing/orthotics have failed to provide relief. Once the posterior tibial tendon has been damaged, it will no longer perform its main function, which is to provide proper support to the arch of the foot. But the exact procedure used will depend on the severity of the patient’s condition.
There are several types of surgical techniques used for posterior tibial tendon reconstruction, including:
- Gastrocnemius recession. This procedure focuses on lengthening the two muscles located in the calf area in order to reduce pressure at the front of the heel as well as improve foot function. Gastrocnemius recession also helps reduce calf tightness, which may prevent the ankle from moving fully upward. Calf tightness can contribute to a variety of problems, including heel pain and difficulties walking comfortably. This surgery treats flatfoot and prevents it from recurring. It may be performed in combination with other procedures used in the correction of flatfoot.
- Tendon transfer. This procedure is performed to correct flatfoot and reconstruct the lost arch in the foot. During the tendon transfer, part of the damaged tendon is removed and replaced by a tendon taken from a different location in the foot. Typically, this is the flexor digitotorum longus(FDL.)
- Tenosynovectomy. A method of cleaning the tendon, this procedure may be used for less severe cases of posterior tibial tendon dysfunction. A tenosynovectomy can be effective when the shape of the foot has not changed but there is swelling and pain over the tendon. During this surgery, inflamed tissue around the tendon is removed and cleaned away.
- Osteotomy. This procedure involves the cutting and restructuring of the bones in the foot into an arch. The heel bone and midfoot section will likely be reshaped when this technique is utilized in order to achieve the best result possible. Screws are frequently used to hold the bones in place as they heal.
- Fusion. Flatfoot may be accompanied by stiffness due to the duration of the flatfoot. This often means that the foot does not have the necessary flexibility to be corrected using tendon transfers or bone cuts. Fusion, also known as arthrodesis, is used to realign the foot, and helping improve the alignment of the foot.
Recovery from a Posterior Tibial Tendon Reconstruction
Posterior tibial tendon reconstruction procedures are generally complex forms of surgery that require a significant recovery period. However, the recovery time from posterior tibial tendon reconstruction will vary depending on the procedure performed as well as the individual patient. The severity of the flatfoot and the amount of motion possible in the ankle area following the procedure are factors that help determine how long it will take for the patient to recover. Some patients may need up to a year to achieve complete recovery.