Posterior Tibial Tendon Reconstruction

The posterior tibial tendon is a large tendon which runs just behind the large bone on the inside of the ankle (called the “medial malleolus”). The tendon helps support the arch of the foot and helps you to rise up on your tip-toes, therefore it has to withstand a lot of stress over your lifetime. The tendon can tear or scar down as you get older or may be injured by a sudden twisting injury of the foot. You may notice pain or swelling over the tendon and your arch may fall (your foot may get flat). Your heel may tilt outward at the same time, and you may feel out of balance and unstable.

Non-operative treatment may include a walking cast or brace and anti-inflammatory medications. When these modalities fail, surgery is discussed.

The Surgery

A simple repair of the posterior tibial tendon does not return satisfactory function. However, there is another tendon called the “flexor digitorum longus”, which moves the four small toes and runs beside the posterior tibial tendon, that can be used to take its place. The tendon to the big toe is then made to take over the function of the flexor digitorum longus tendon.

Most of the time, we also make a cut in the heel bone (the “calcaneus”) and move the back part of it toward the inside of the foot. This helps make the arch of your foot higher and helps take some of the stress off the tendons on the inside of your foot.

Surgery & Recovery

The surgery is done as an outpatient (you do not need to be admitted to the hospital).

Day of the Surgery: You will have a bulky dressing that comes up to just below the knee. You need to keep your leg up above your heart as much as possible for the first five days to keep the swelling down. You cannot walk on the foot. Some patients like to practice with crutches even before the surgery.

2 Weeks: We will take out your stitches and put you in a cast. You still cannot walk on the foot.

1 Month: We will put you in a removable cast boot and let you gradually start putting weight on the foot.

2-3 Months: You can gradually wean yourself out of the cast and we will teach you exercises to get the strength back in the tendon we moved over.

Around 4 Months: Most patients get back to full normal activities, but a little soreness with heavy activity can persist until about 9 months.