Tibialis Posterior Tendon Decompression (stage 1 disease)
Surgery is performed under general anesthetic. The stay is usually 1-2 nights. The procedure takes 1hour. The aim of surgery is to remove the inflamed tissue and repair any damage to the tendon.
Technique
A 10cm incision is made on the inner side of the ankle starting just above and behind the bony prominence then curving down into the foot. The sheath in which the tibialis posterior tendon runs is opened, and all the inflamed tissue is taken out. The tendon is inspected, and any damaged tendon is either removed or repaired depending on its condition. The sheath is then repaired, and the skin is stitched. A below knee half plaster cast is then applied while you are still asleep.
Risks
All surgery carries potential risks. The risks are minimized by having the surgery meticulously performed by an expert in foot and ankle surgery. Risks include
- Pain, swelling, and bruising - will occur to some degree following all foot and ankle surgery
- Infection - approximately 2% risk in our unit
- Blood clots (thrombosis) – treatment to reduce this risk will be provided if required
- Numbness – usually improves over time
- Stiffness – this improves over time and helped by physiotherapy
- Scar sensitivity - can be improved with scar massage
- Incomplete improvement - occasionally symptoms will be improved but remain present to a small degree. Recurrence in the inflammation can also occur
- Revision surgery - if primary surgery fails to improve symptoms
Discharge advice following Tibialis Posterior Tendon decompression
Dressings
Your leg has been dressed in a plaster back-slab to give it support. This dressing should not be changed until you are seen at your first follow-up appointment after 2 weeks. The plaster must be kept clean and dry.
Elevation
It is very important that you rest as much as possible and keep your foot elevated for the first 48 hours after surgery. Try to avoid letting it hang down when sitting as this will lead to swelling and pain. This is most apparent within the first 2 weeks but swelling may occur for up to 6 months after surgery, especially after sitting or standing for long periods. In bed, put the foot on a pillow.
Analgesia
You will receive a prescription for pain medication on discharge. Pain is often due to swelling, and this is eased by rest and elevation of the foot.
Walking
You will need to walk without putting any weight on the foot for 2 weeks. A physiotherapist will show you how to use crutches After this you will be supplied with a removable boot that has Velcro straps. You will then be able to walk in the boot during the day and put all your weight on it. This is worn for 4 weeks. You can take the boot off at night.
Follow-up
You will be seen approximately 2 weeks when the plaster and sutures will be removed. You will be placed in a walking boot in which you can walk in. You will be seen again 4 weeks later and if all is well will be referred to the physiotherapists and you can discard the boot. You will need a small shoe insert to maintain your arch and heel alignment support during the next 6 weeks, and this will be provided. This can be worn inside trainers and these should be brought to the6 week appointment. You will be seen at 3 months for a final check.
Driving
You should not drive a manual car for 6 weeks following surgery. After this you should start gradually, to see if you are comfortable. It normally takes a few days to feel confident.
Work
If you have an office-based job then it may be possible for you to return after 2 weeks however it is more advisable to return after 6 weeks. If you have a more physical job, then it may take 8-12 weeks.
Recovery
It often takes 6 months for all swelling to resolve and so minor swelling late in the day is not unusual and should not be a cause for concern. It will take 6 months to return to full sporting activity.