Reconstruction of Posterior Tibial Tendon Tear with Tendon Transfer
When there is a more significant injury to the posterior tibial tendon than can be simply repaired, a tendon transfer is done to reinforce the torn tendon. I transfer the flexor digitorum longus (FDL) tendon that runs parallel to and just behind the torn tendon at the ankle. It is readily available to use, and you will have no loss of function when it is transferred. The FDL tendon helps curl your toes downward. But there are also muscles in the foot that will curl the toes. Therefore, you can still curl your toes after the FDL tendon is used to reconstruct the posterior tibialis tendon.
The FDL tendon is woven through the posterior tibial tendon, and sewn into the navicular bone on the inside of the hindfoot. I usually will also reconstruct a ligament that supports the arch, the Spring Ligament, during this same procedure. That involves drilling a second hole in the heel bone, and adding a supportive suture mesh called an Arthrex Internal Brace that spans the undersurface of the arch just deep to the FDL tendon. You will be left with a curving scar that runs along the inside of the ankle and hindfoot for about 5 inches.
The surgery is done as an outpatient, and you will require a general anesthetic.
Day of Surgery
At the end of the surgical procedure the wound is covered and a short leg plaster splint is applied with the toes pointing downward and inward (plantarflexed and inverted). That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.
You will be given crutches at the surgery center, and I want you to not put any weight on that leg during the first 6 weeks. Do not walk on the splint.
Look here for things to watch for after outpatient surgery.
Dealing with post-operative pain will be your major concern for the first few days.
Most people find that for the first few days after surgery their foot will feel better if it is elevated. Generally, if you let it hang down for any period of time it will throb and you may have more swelling. You can put it into whatever position feels best, but usually that will be elevated with a pillow under the foot.
The first post-operative visit is usually 7 – 10 days after surgery. I will remove the splint and dressings, wash your leg, and take out the skin stitches.
I will put you into a short leg cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is at the 6 week point after surgery. I will remove the cast, and check to make sure that everything is healing satisfactorily. You will then go into a CAM Walker, and you will wear that for protected weightbearing for an additional 6 weeks. You may remove it to do gentle motion exercises. You must wear it when you do any walking.
I will ask to see you one more time after an additional 6 - 8 weeks. If there are any problems or questions then we will deal with them as they present.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. You should not resume athletic activities for about 6 months after surgery.
The goal of the surgery is to leave you with a painless foot and leg that will allow normal activities. You should be able to regain full strength and power in the leg and ankle, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.
Complications can occur after any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this procedure include persistence of pain, and the need for further treatment with a brace or another operation.