Tibial Tendon Disorder >
Preparing for Surgery
Surgical debridement of the posterior tibial tendon
typically is performed on patients who continue to have
ankle pain after four to six weeks of conservative treatment.
Candidates for debridement surgery generally do not
have bone deformity in their foot and do not have tears
in their posterior tibial tendon. Debridement ordinarily
is an open procedure. Patients commonly can leave the
hospital the same day after surgery. If you and your
physician have decided on surgical debridement to treat
your posterior tibial tendon disorder, the decisions
you make and the actions you take before your surgery
can be every bit as important as the procedure itself
in ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
possible, practice walking with your crutches so you
are ready to use them after surgery.
a second opinion from another qualified surgeon is often
advisable, especially in rare or unique cases.
sure the orthopedist performing the surgery is board-certified
or eligible, which can be determined by calling the
American Board of Orthopaedic Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
At most medical centers, you will
go to "patient admissions" to check in for
your operation. There may be separate check-in areas
for ambulatory outpatient (patients go home the same
day after surgery) and for overnight inpatient surgery,
so be sure to ask your doctor or one of his assistants
about this. After you have checked in to the hospital,
you will go to a holding area where the final preparations
are made. The mandatory paperwork is completed, and
your ankle may be shaved, though this is not always
necessary. You will be asked to change into a hospital
gown and, if applicable, remove your watch, glasses,
dentures, and jewelry. You will have the opportunity
to speak with your orthopedic surgeon or one of his
assistants and meet the anesthesiologist or nurse anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). An IV
(intravenous) line may be inserted into your arm at
this time. Then, you will walk or ride on a stretcher
to the operating room. Most patients are not sedated
until they go into the operating room. Here are some
important things to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, arrange for someone to drive you home
when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgical debridement of your posterior
tibial tendon usually takes about two hours to perform.
Spinal anesthesia typically is given to numb you from
the waist down, and you usually are sedated so that
you sleep through the procedure.
12- to 14-centimeter incision is made down the back
of your lower leg, along the length of your posterior
sheath covering your tendon is opened up.
rough, inflamed, or damaged tissue is cut away (debrided),
which smoothes the tendon surface and exposes the healthy
incision is closed with stitches and your ankle is put
into a splint to immobilize it. You are then taken to
the recovery room.
After surgical debridement for a posterior tibial tendon
disorder, you will be transported to the recovery room,
where you will be closely observed for one to two hours
while the immediate effects of anesthesia wear off.
Your ankle will be immobilized in a splint when you
wake up, and your ankle will be elevated. After surgery,
you usually experience some pain. Adequate pain medications
will be prescribed for you. You will be given IV, oral,
or intramuscular pain medications as needed. Your surgeon
will prescribe crutches, and you are usually instructed
to keep all weight off your ankle for two to four weeks.
Your temperature, blood pressure, and heartbeat will
be monitored by a nurse who, with the help of the doctor,
will determine when you can prepare to go home. Most
patients are able to leave the hospital or clinic the
same day. Make sure to have someone available to drive
you home, as you will be unable to drive a car.
Crutches are usually prescribed for
about four to six weeks after surgical debridement for
posterior tibial tendon disorder. Rest as much as possible
with your ankle elevated above the level of your heart.
This helps blood drain away from your ankle and controls
swelling. It is essential to keep as much weight as
possible off your ankle. The more weight you put on
your ankle, the greater your chances of further damaging
the tendon. Household tasks that require you to be on
your feet may be difficult for four to six weeks. It
can be helpful to have someone around the house who
can help with any physical chores. You will most likely
return to your physician’s office in 10 to 14
days to have the post-surgery ankle splint replaced
by either a short leg cast or a splint called a cam
walker. To keep the cast dry, either wrap a plastic
garbage bag around the cast while showering or bathe
with your leg out of the tub. You probably will be told
not to bear any weight on your ankle while wearing the
cast or cam walker for two to four weeks. Typically,
you will return to your physician for check-up visits
every two weeks until your tendon has healed. If your
ankle was immobilized in a cast, it may be removed and
your ankle may be put into a removable cam walker before
you return to normal shoe wear. In general, you should
continue using your crutches and wearing your cast or
cam walker as instructed by your doctor until symptoms
resolve. You will probably begin partial weight bearing
in a brace or cam walker before going back to normal
shoe wear. Your physician may suggest physical therapy
that can be done at home, or refer you to a physical
therapist when your cast comes off. After about four
weeks, your physician generally sees how well you have
been progressing with your range of motion exercises.
to call the doctor after surgery
The rehabilitation period after a
posterior tibial tendon disorder can vary. Most patients
can restore strength in their ankle in three to four
months, though your individual range of motion and strengthening
exercise schedule should progress as you can tolerate
it. Your physician ordinarily prescribes range of motion
exercises for you to perform at home after your cast
is removed. Patients generally are instructed to remove
their brace or cam walker for a brief period and prop
their lower leg on a stool or pillow so your ankle is
off the floor. Many physicians recommend moving your
ankle up-and-down, and side-to-side. Start with slow
movements and do not move your ankle too far in any
direction. The goal is to strengthen your posterior
tibial tendon enough to support your arch and control
your foot and ankle motion during activities. When you
come out of your cast or cam walker, your ankle typically
feels stiff and you should take it easy as you begin
walking in normal shoes. You should perform ankle range
of motion exercises three times a day. You typically
progress to light cardiovascular exercise and then strengthening
exercises. If you experience episodes of pain or discomfort
while exercising, have your physician examine your ankle.
Athletes who want to return to sports as quickly as
possible typically undergo supervised physical therapy.
This also may be prescribed for patients who do not
make good progress strengthening their ankles on their
To prevent reinjury of your posterior
tibial tendon, physicians generally recommend strengthening
the leg muscles that help pull your arch up, including
the peroneal muscles on the side of your leg and your
anterior tibial tendons in the front. Orthotics that
support your arch can help to protect your posterior
tibial tendon and help relieve tension on the tendon
as it transfers weight. You usually can go back to wearing
normal shoes, even flat work shoes, but the orthotic
insert should be worn at all times. In general, sports
that put repetitive stress on your ankles, such as long
distance running, may increase your risk of reinjury.
If possible, you may want to switch to a sport such
as cycling that puts less strain on your ankle. Before
engaging in sports and activities, remember to include
ankle stretches in your warm-up routine. Most younger
patients can recover fully from a posterior tendon disorder
and return to a normal level of activity. Middle-aged
patients typically can go back to tennis or golf, but
physicians generally recommend avoiding high-repetitive
sports like running.