Introduction
When this tendon is inflamed or torn, it’s classified as a posterior tibial tendon dysfunction and can no longer provide stability and support for the arch. If the arch begins to flatten, that condition is called an adult acquired flatfoot.
This injury can occur from a fall, a tear due to overuse, or stress from high impact sports such as basketball, tennis or soccer. The impact from the repetition of walking, working, sports, and exercise aggravates the tendon; making it vulnerable to tears. Once the tendon is afflicted, pain is experienced on the inside of the foot. In addition, the area can swell, pain worsens with increased activity, and the heel can shift out of position.
Conservative Treatment
In order to treat this condition without surgical measures, it is recommended to rest the foot and decrease the level of activity to reduce pain. Icing, compression, and elevation are also recommended to control swelling in the foot as well as taking nonsteroidal anti-inflammatory medication to help with inflammation in the foot. The application of a brace to provide support to the weakened tendon and realign the foot is usually prescribed. Cortisone injections can be administered around the tendon in certain conditions.
Surgical Treatment
If conservative treatments are not helping in the recovery process, surgery may be performed. The procedure is dependent on how severe the pain and damage is and where the tendon is located. There are four procedures to help restore the tendon. A procedure known as a gastrocnemius recession, or surgical lengthening of the calf muscles, can be done. This prevents flatfoot from occurring but does create weakness when the foot pushes off the ground. The surgeon can perform a tenosynovectomy, which is cleaning of the tendon when it suffers the effects of a mild disease. The tendon will be cleaned and inflamed tissue surrounding the tendon is removed. Tendon transfer is another procedure that aims to recreate the function of the damaged tendon by replacing it with a tendon from the foot. Surgery called an osteotomy can be done. This procedure changes the shape of a flatfoot and restores the normal arch shape. One or two bones will be cut in order to recreate the shape and, if the tendon is not salvageable, it will be removed and replaced by another tendon from the bottom of the foot. Finally, if arthritis has developed in the foot, a fusion of three of the major foot joints, a procedure called a triple arthrodesis, is usually performed.
After the surgery a 2 -3 month period of non-weight bearing is usually necessary before weight bearing begins. This is followed by a 12 week period of extensive physical therapy.
