Once conservative treatments have failed in treating
posterior tibial tendon dysfunction, surgery can be looked at as a potential
way to reduce pain and correct the collapsed arch. There are a wide variety of procedures that
have been used. Some involve repairing
tendons or other soft tissues. Others
involve making cuts in bone to shift their position to reestablish their
correct position. If there is cartilage
damage or arthritis in the joint, fusing the joints may be beneficial. We’ll discuss each category of procedures.
Before any surgical decisions are made, an MRI should be
ordered and reviewed with your doctor.
With the help of an MRI, the entire length of the posterior tibial
tendon can be analyzed and the extent of damage can be determined. If cartilage damage is present, this will be
obvious on the MRI images. MRI is an
important tool that is essential for determination of the best procedure.
If the condition is not too far advanced, a soft tissue
procedure can be done to help stop progression of the problem. This may involve repairing the damaged
tendon, or transferring a healthy tendon to take its place. In some cases, using a tendon graft can help
strengthen the tendon. The nice thing
about these procedures is that once the incision is healed (about 2 weeks), you
can walk on the foot which was operated on.
If the condition is too far advanced, a soft tissue
procedure will not be powerful enough to correct the problem. In such cases, bone must be cut in order to
re-align the foot under the body. These
procedures provide more correction than the soft tissue procedures. In situations where cartilage damage is
present, the surgeon may choose to fuse the damaged joint. Although these procedures are more definitive
and have more potential benefit, the recovery time is much longer. When bone is cut, the patient should be
non-weight bearing for up to 6 weeks to allow the bone to heal in proper
position. Additional non-weight bearing
time may be necessary depending on how fast each particular patient heals. The doctor will want to see you every 2-3
weeks to take xrays to insure proper healing.
