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.
PTTD is a difficult condition to treat. Discuss with your podiatrist which procedure option best suits your situation. Most patients see dramatic reduction in pain and a foot that allows for normal ambulation.