Posterior Tibial Tendon Reconstruction with FDL Tendon Transfer, and Calcaneal Osteotomy
When a posterior tibial tendon tear has been present for a few months the tendon loses its ability to hold up the arch, and a flatfoot deformity can develop. When flattening of the arch has occurred a more complex reconstruction must be done. In addition to reconstruction with a FDL tendon transfer, the heel bone (calcaneus) is cut and shifted back under the weightbearing axis of the leg. During that procedure a screw is placed into the heel bone to hold the shifted position. That generally stays in the rest of your life. You will have 3 scars, a 5 inch curving scar over the inside of the ankle and hindfoot, a 3 inch oblique scar over the lateral side of the heel, and a 1 inch scar at the posterior lateral heel.
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 week.
Post-operative Course 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.
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 an additional 6 weeks you must wear it when you do any walking.
I will ask to see you one more time after an additional 2 – 3 months. 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 ankle 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.
Specific risks of this procedure include persistence of pain, and the possible need to have further surgery including a triple arthrodesis. Some people have tenderness where the screw is placed into the posterior heel. If that is the case, it can be removed after 6 – 12 months as another outpatient procedure.