Tibialis posterior tendon repair

Tendons are the name given to strong bands of connective tissue which form the attachment of muscles to bone. The tibialis posterior tendon connects the tibialis posterior muscle which lies on the inside of the calf to the inside border of the foot.

Under normal circumstances, the tibialis posterior muscle and tendon provide the main supporting structure to maintain the characteristic arch of the foot as well as provide propulsive power and stabilise the ankle and foot to resist sideways movements.

In circumstances where the tibialis posterior tendon has been torn surgeons may consider a tibialis posterior tendon repair.

Prior to your operation, a full medical screen conducted by a specialist nurse and anaesthetists will be conducted to ensure you are safe to undergo the anaesthetic. The surgical team will review MRI scans as needed to better plan the exact site of incision and which part of the tendon needs to be operated upon.

Firstly, the surgeon will carefully make an incision following the line of the tendon in the lower leg. The surgeon will then make another careful incision through the tendon sheath that encapsulates the tibialis posterior tendon.

Once appropriately visualised, any significantly damaged tendon tissue which may be contributing to ongoing pain is carefully removed. Tears to the tendon will then be stitched to allow them to heal appropriately.

Risks following a tibialis tendon repair are very rare and our ultra-clean and safe environments within our hospitals are designed to minimise any complications.

• Drowsiness and nausea after the general anaesthetic
• Blood clot in the legs known as a deep vein thrombosis
• Blood clot in the lungs known as pulmonary embolism
• Infection to the wound or within the tendon or tendon sheath
• Damage to the tibial nerve

However, many tibialis tendon tears occur in individuals with poor tendon tissue quality and/or an inherited flat-foot position which places the tendon under significantly more load during everyday tasks and sports.

Due to this, the tendon repair may fail and some patients are better suited to a more invasive procedure to correct the underlying foot posture known as a tendon transfer operation and calcaneal (heel) osteotomy.

Due to the possibility of the repair failing a period of six to twelve weeks of immobilisation and non-weight bearing is required following a tibialis tendon repair operation.

Once it is clear that the tendon repair has taken appropriately, a lengthy period of strengthening the tibialis posterior muscle and tendon is needed under strict supervision from physiotherapists.

With the appropriate, graded strengthening plan, the tibialis posterior muscle and tendon will grow in tensile strength and be able to take normal levels of load with weight bearing and walking again.

Depending on the severity of the initial injury and the success of the repair sportsmen and women may be able to successfully return to sport following six to twelve months of rehabilitation.