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The tibialis posterior is a muscle in the lower leg. The tendon from this muscle runs behind the inside bone on the ankle (called the medial malleolus), across the instep and attaches to the bottom of the foot. The tibialis posterior is important as it helps to hold the arch of the foot up and stop the foot rolling over. Sometimes the tendon becomes stretched and inflamed. This condition can be called Tibialis Posterior Tendon Dysfunction, Tibialis Posterior Insufficiency or Acquired Adult Flat Foot.

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Surgery is usually performed when non-surgical measures have failed. The goal of surgery is to eliminate pain, stop progression of the deformity and improve a patient’s mobility.

More than one technique may be used, and surgery tends to include one or more of the following:

  • The tendon is reconstructed or replaced using another tendon in the foot or ankle The name of the technique depends on the tendon used:
  • Flexor digitorum longus (FDL) transfer
  • Flexor hallucis longus (FHL) transfer
  • Tibialis anterior transfer (Cobb procedure)
  • Calcaneal osteotomy – the heel bone may be shifted to bring your heel back under your leg and the position fixed with a screw
  • Lengthening of the Achilles tendon if it is particularly tight
  • Repair one of the ligaments under your foot

If you smoke, your surgeon may refuse to operate unless you can refrain from smoking before and during the healing phase of your procedure. Research has proven that smoking delays bone healing significantly.

A physiotherapist will see you on the ward and teach you how to walk using a walking aid. If you have to use stairs at home you will be taught the safest way to do this.

You will usually stay in hospital for approximately one to two days after your operation. Treatment is individual for each patient. However, it is normal, following a tendon transfer and calcaneal osteotomy, for you to have a plaster cast in place following your operation. Your foot may be placed in an inverted position (facing inwards). You need to make sure that you do not get the plaster wet.

  • Improved function/mobility/muscle strength
  • Improved pain relief and less need to take painkillers
  • Improved arch height and alignment
  • Stop the progression of the deformity
  • Able to do a single heel raise
  • Returning to low impact sports may be possible but strenuous sport is unlikely
  • Full recovery may take up to twelve months.
  • Swelling You should expect some swelling after your operation. If swelling persists or worsens and you are concerned, seek advice from a member of the foot and ankle team or your GP.
  • Infection any operation is at risk of infection. Fortunately it is not common in this type of surgery but a small number of patients do get a wound infection and these normally settle after a short course of antibiotics. In rare circumstances, the infection may be more severe and require further surgery to remove infected tissue and administer a longer course of antibiotics.
  • Blood clots Deep Vein Thrombosis (DVT) or Pulmonary Embolus (PE) are rare but can occur. Please inform the team if you have had a DVT or PE in the past or if you have a family history of clotting disorders. You will be given an anti-embolic stocking to wear on your other leg and daily blood thinning injections while your leg is in plaster.

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