What is posterior tibialis tendon surgery?

Posterior tibialis tendon surgery is a way to fix the tendon on the back of your calf that goes down the inside part of your ankle. A surgeon can do a few different types of surgery to fix this tendon.

The posterior tibialis tendon is a strong cord of tissue. It's one of the most important tendons in your leg. It attaches the posterior tibialis muscle on the back of your calf to the bones on the inside of your foot. It helps support your foot and hold up its arch when you are walking.

An injury might tear this tendon or cause it to become inflamed. Your tendon might also tear or become inflamed from overuse. Surgery is used to correct this damage.

During the surgery, you will likely get general anesthesia so that you sleep comfortably during the surgery. The surgeon will make a cut in the back of your lower calf. Then the surgeon will either remove or fix the damaged portion of your tendon. If there is damage to a lot of your tendon, the healthcare provider might replace part or all of it with a tendon taken from another place in your foot. Other methods may also be used to repair your tendon as well.

In some cases, a surgeon may do the surgery as a minimally invasive procedure. This means using several small cuts (incisions) instead of 1 large one. Then the surgeon may use a tiny camera and small tools to do the repair.

Why might I need posterior tibialis tendon surgery?

If you recently tore your posterior tibialis tendon, you might need this surgery. A tear can happen during a fall. It can also happen if you recently broke (fractured) your ankle or dislocated it. Surgery may also be done for long-term (chronic) inflammation from overuse. High-impact sports like basketball, soccer, or tennis can cause tears due to repetitive use. You may also have problems with the tendon if you have diabetes or high blood pressure. Also if you are obese, older than age 40, or were assigned female at birth.

If your tendon becomes inflamed or torn, the arch of your foot may start to slowly fall. This can cause pain and swelling in your foot and ankle.

Your healthcare provider may try other treatments first. These can include things like:

• Resting your foot

• Using ice

• Taking pain medicines

• Wearing a brace, orthotics, or a boot

• Doing physical therapy

If you still have symptoms after several months, your healthcare provider might advise surgery. Your provider might be more likely to advise surgery right away if you hurt your posterior tibialis tendon very badly or if the injury happened suddenly.

Depending on your problem, 1 or more types of surgery might work for you. Talk with your provider about the risks and benefits of all your options.

What are the risks of posterior tibialis tendon surgery?

Every surgery has risks. Risks for this surgery include:

• Excess bleeding

• Nerve damage

• Blood vessel damage

• Infection

• Blood clot

• Weakness of your calf muscles

• Complications from anesthesia

• Continued pain in your foot and ankle

Your risk of complications may vary by your age, the anatomy of your foot, your general health, and the type of surgery done. Talk with your provider about any concerns you might have. You can discuss the risks that most apply to you.

How do I get ready for posterior tibialis tendon surgery?

Talk with your healthcare provider about how best to get ready for your surgery.

Tell your provider about any medicines you are taking, including:

• All prescription medicines

• Over-the-counter medicines such as aspirin or ibuprofen

• Illegal drugs

• Herbs, vitamins, and other supplements

Ask if there are any medicines you should stop taking, such as blood thinners.

If you smoke, try to quit before your surgery.

Follow all directions you're given for not eating or drinking before your procedure.

Tell your provider about changes in your overall health, such as a recent fever.

Before your procedure, you may need imaging tests such as an X-ray or magnetic resonance imaging (MRI) scan.

You may need to plan changes to your home or activities. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone available who can drive you home from the hospital.

Follow any other instructions from your healthcare provider.

What happens during posterior tibialis tendon surgery?

Surgeons use a variety of methods for posterior tibialis tendon surgery. Ask your healthcare provider about the details of your surgery. An orthopedic surgeon will do your surgery, helped by a team of healthcare providers. The procedure may take 2 or more hours. In general, you can expect the following:

1. You will most likely be given general anesthesia so you can comfortably sleep through the entire procedure. You may instead have spinal or regional anesthesia, so you won’t feel anything from your waist down. You will also be sedated so you’ll sleep through the procedure and won’t remember it afterwards.

2. A healthcare provider will carefully watch your vital signs, such as your heart rate and blood pressure.

3. Your surgeon will make an incision through the skin and muscle of your lower calf.

4. If you are having a minimally invasive procedure, your healthcare provider will make a small incision and use small tools and a tiny camera to perform your surgery.

5. Your surgeon will make an incision through the sheath that surrounds the tendon. The surgeon will then remove or repair parts of your damaged tendon.

6. In some cases, your healthcare provider may remove another tendon from your foot. This is then used to replace part or all of your posterior tibialis tendon. Sometimes bone procedures are done to support the tendon.

7. The layers of skin and muscle around your calf are stitched closed.

What happens after posterior tibialis tendon surgery?

A healthcare provider will watch you for a few hours after your surgery. When you wake up, your ankle will be immobilized in a splint. Often, posterior tibialis tendon surgery is an outpatient procedure. This means you can go home the same day. Follow all of your provider’s instructions about pain medicines and wound care.

You will have some pain after your surgery, especially for the first few days. Medicines can help lessen your pain. Keeping your leg raised after the procedure may help reduce swelling and pain as well. You’ll need to use crutches and keep your weight off your leg for a few weeks. Make sure to tell your provider right away if you have a high fever, chills, or if the pain from your ankle or calf is getting worse.

About 10 days or so after your surgery, you will probably have your stitches or staples removed. Your provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. In other cases, your provider may give you a special removable boot instead of a cast.

Your provider will give you instructions about when you can put weight on your leg and how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy as well. You may have pain for months before you start to notice major benefits from your surgery. Follow all of your provider’s instructions about post-surgery exercises. This will help make sure your surgery is a success for you.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure