Tendons not only connect muscles to bones, they transmit the mechanical force of muscle contraction to the bones, which is what makes movement possible. One of the most important tendons in the leg is the posterior tibial tendon. It attaches the bones along the inside of the foot to the calf muscle in the lower leg; its main function is to support the arch and allow the heel to elevate off the ground when walking.
A tear in the posterior tibial tendon, also known as posterior tibial tendon dysfunction, is a common condition of the foot and ankle. Damage to the posterior tibial tendon from tearing or degeneration results in loss of support and stability for the arch, leading to gradual collapse. This progressive condition is called Adult Acquired Flatfoot Deformity.
Causes of Posterior Tibial Tendon Tears
Tears in the posterior tibial tendon and the resulting flatfoot can have many different causes. The risk tends to be higher in women, and it does increase with age. Some of the other common causes include:
- Injury or trauma, such as falling or car accident
- Overuse, often from activities like walking, running, climbing, hiking, and high-impact sports
- Diseases and conditions such as diabetes, rheumatoid arthritis, hypertension and obesity
Symptoms of Posterior Tibial Tendon Tears
Symptoms and signs of tearing in the posterior tibial tendon may be present in both feet but happen independently. These include:
- Pain on the inside of the ankle made worse by physical activity
- Inflammation and reddening of the skin
- Visible flattening of the foot as the arch collapses
- Inability to come up on your toes on the affected side
Treatment for posterior tibial tendon tears and flatfoot will begin with conservative, noninvasive methods. Typically, this can involve some combination of rest, ice, nonsteroidal anti-inflammatory medications, bracing, orthotics, and physical therapy.
Posterior Tibial Tendon Reconstruction Procedure
In those cases where conservative treatment proves ineffective, your orthopedic surgeon may recommend reconstruction surgery. Several surgical options are available and which one your surgeon determines appropriate will depend on the severity of your condition. Some of the most commonly used procedures include:
- Tendon Transfer – performed to correct flatfoot and restore function to the arch, all or part of the damaged or diseased posterior tibial tendon is removed and replaced by another tendon from the foot — typically the flexor digitorum longus (FDL) tendon, one of the two tendons responsible for movement in the lesser toes.
- Tenosynovectomy – this procedure is typically used in the earlier stages of posterior tibial tendon dysfunction and in cases that are less severe before the arch has collapsed or there has been significant change to the shape of the foot. Tenosynovectomy is a debriding technique in which the inflamed or damaged tendon tissue is removed. This serves to decrease pain and prevent damaged tissue from contributing to further problems.
- Osteotomy – this type of correction for restoring the function of the arch involves cutting and reshaping one or more bones in the foot, usually the heel bone (calcaneus) and a bone from the midfoot area. These bones will be reshaped to form an arch and then held in place by screws or plates while they heal. If the flatfoot condition is particularly severe, a bone graft may also be done to increase the length of the outside of the foot.
- Fusion – also known as arthrodesis, is designed to improve the alignment of the foot and involves joint fusion. It is used in those instances in which the foot has lost flexibility because of a long-standing flatfoot deformity. Joints in the back of the foot are fused, creating a more realigned functioning foot.
- Gastrocnemius Recession – also referred to as “lengthening of the achilles tendon,” this procedure is designed to lengthen the calf muscles and tendons in the back of the leg. Tightness in the calf can lead to a range of issues, including heel pain and interference with the ankle’s ability to flex upward, which makes it difficult to walk comfortably. This type of procedure is performed at times along with the above procedures and can prevent it from recurring.
Recovery time from posterior tibial tendon reconstruction will depend on the severity of the condition and the technique or techniques used. For some patients, it may take a year before there is significant improvement in pain. How advanced the flatfoot was and what degree of motion the patient had in the foot prior to surgery will largely determine, not only how long the recovery period will be, but also how likely it is that the patient will be able to return to activities like sports.
Contact Dr. Hubbard to Make an Appointment For Posterior Tibial Tendon Reconstruction
If you have been diagnosed with flatfoot or are experiencing pain in your foot and believe it may be related to posterior tibial tendon tearing, Dr. Christopher Hubbard has the experience and training to provide you with options, designed specifically for you, to give you the very best potential for recovery. Contact our office today to discuss your treatment options.