Ankle > Posterior Tibial Tendon Disorder > Treatments

   Surgical Debridement

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.

   Prior 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.

   Any 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.

   Learn 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.

   If possible, practice walking with your crutches so you are ready to use them after surgery.

   Getting a second opinion from another qualified surgeon is often advisable, especially in rare or unique cases.

   Make 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.

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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:

   You 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 anesthesia.

   Since 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.

   Wear 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.

   Take 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.

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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.

   A 12- to 14-centimeter incision is made down the back of your lower leg, along the length of your posterior tibial tendon.

   The sheath covering your tendon is opened up.

   Any rough, inflamed, or damaged tissue is cut away (debrided), which smoothes the tendon surface and exposes the healthy tissue underneath.

   The incision is closed with stitches and your ankle is put into a splint to immobilize it. You are then taken to the recovery room.

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.

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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 own.

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.