Tibialis posterior tendon repair

The cost of tibialis posterior tendon repair with Circle Health Group depends on a variety of factors, including the type of surgery you have and where you have it. Your healthcare team will ensure you know the cost of your treatment at every stage of your journey with them, including information on how and when to pay it.

Fixed-price packages

Our fixed-price packages include the cost of your surgery and all appropriate aftercare appointments. However, any pre-surgery diagnostic tests and your consultant's outpatient appointment consultation fee are charged separately.

Spread the cost of your payment

Our flexible payment options help you spread the cost of your payment across a time period that suits you. We offer fixed-term monthly payment plans over 10 months to five years with no deposit required. If you decide to pay over 10 months, you will pay interest-free. If you are paying for a longer period, you will pay 14.9% APR.

Private health insurance

If you have private health insurance, your treatment will usually be covered by your provider. Speak to your insurer directly to find out more information on this.

If you have any questions about our fixed-price packages and flexible payment options, you can speak to a friendly member of our advisory team on 0141 300 5009.

If you have a tibialis posterior tendon that has become inflamed or damaged, one of the most obvious symptoms that you may develop is flatfoot, which occurs when the arch at the bottom of your foot is no longer present, causing your feet to press flat on the ground.

Other symptoms that suggest you might need tibialis posterior tendon repair include:

• Pain along the inside of your foot and ankle
• Swelling on the inside of your foot and ankle
• Pain that gets worse after intense activity (running, jumping, etc)
• Pain on the outside of your ankle
• Your heel bone shifts to a new outward position, putting pressure on your ankle bone

It is not always clear what has caused your tibialis posterior tendon damage. In most instances, however, you might need tibialis posterior tendon repair because of one of three causes: overuse, injury, or an underlying health condition.

Tendon overuse

If you do a high-impact sport that involves placing intense pressure on your feet (football, basketball, tennis, etc), you are at a greater risk of putting strain on your tibialis posterior tendon. This tendon plays a crucial role in facilitating foot flexibility and movement, which is obviously important when playing these sports.

Over time, constant stretching and contracting can weaken your tendon, making it more likely to become torn or inflamed, which prevents it from maintaining the arched shape of your foot.

Injury

You may also experience a tibialis posterior tendon tear because of an injury. This might be a fall, an injury caused by sudden twisting motion, or an impact injury. If you fracture and/or dislocate your ankle, the trauma to your bones and surrounding tissues can put pressure on your tibialis posterior tendon and lead to it becoming inflamed.

Medical conditions

If you are obese, there is a greater risk of you experiencing problems with your tibialis posterior tendon. Diabetes is another risk factor as well. This is because the extra sugar in your blood increases the development speed of your advanced glycation end products (AGEs), which form when protein mixed with sugar in your bloodstream. By forming a bond with the protein that makes up your tibialis posterior tendon, the overly active AGEs can change its structure and how well it works.

Your consultant will take care to learn about the severity of your tibialis posterior tendon issue, as this helps them understand what treatment is best suited to you. This will most likely include taking a medical history, physical examination, and a series of imaging tests.

Medical history

Your consultant will ask about your symptoms - where you feel them, how long they have been present for, and what caused them to develop in the first place. They will also check if you have any previous history of treatment for your tibialis posterior tendon, whether you've had these issues before, and confirm any health conditions that may have contributed to your condition (e.g. diabetes).

Physical examination

To understand the extent of your tibialis posterior tendon damage, your consultant will conduct a thorough physical examination of your foot, which may include checking for the following:

• Swelling from your lower leg to the inside of your foot and ankle
• Change in the shape of your foot (seeing if you have flat feet)
• Single limb heel rise test (seeing if you can stand on your tiptoes, which is a sign of a healthy posterior tibial tendon)
• Levels of flexibility (moving your foot from side to side)
• Range of motion in your ankle
• Looking at your heel from behind to see if more of your little toe is visible (a sign of flat feet)

Imaging tests

Along with taking down your medical history and examining your foot and ankle, your consultant may also do some imaging tests to clarify the severity and exact nature of your tibialis posterior tendon problem. These can include:

X-rays

Allows your consultant to clearly see the structure of the bones in your foot and ankle and whether it has been affected by inflammation. This test is particularly helpful for seeing if you have developed arthritis in your tibialis posterior tendon.

CT scan

Provides a more detailed image than an X-ray, picking up cross-section images of your foot and ankle. This further supports your consultant to see if any arthritis is present, along with whether there has been any damage to your bone structure.

MRI scan

An MRI creates images of your soft tissues (tendons, muscles, ligaments, etc), which means your consultant can see how much inflammation there is around your tibialis posterior tendon, as well as the severity of any tears that may have occurred. This is usually done when your diagnosis is still uncertain.

To start with, your consultant will initially recommend a series of non-surgical tibialis posterior tendon repair treatments, such as:

Rest and ice

The first step will be to rest your affected foot. In cases where your tibialis posterior tendon inflammation is new or not too severe, pausing the activities that led to your symptoms can be enough to reduce the inflammation around your tendon and relieve you of any discomfort. This is usually accompanied by applying ice - 20 minutes at a time for three or four times a day - to further bring down the swelling around your tibialis posterior tendon. Various anti-inflammatory medications, such as ibuprofen or naproxen, could also be suggested.

Braces and orthotics

Braces and orthotics have been shown to be an effective form of help for people with an inflamed or torn tibialis posterior tendon. Orthotics are shoe inserts that can either be bought over the counter or custom-made to suit the shape of your foot and restore it to its correct position, which in turn supports your tendon to regain its strength. Braces, in a similar way, support the joints in the back of your foot, taking pressure off the tendon, which should ease your symptoms.

Immobilisation

Your consultant may recommend wearing a short leg cast or walking boot, which supports your tendon to rest and gives the swelling some time to go down. You will need to keep this on for anywhere between six and eight weeks, depending on how much your symptoms go down. This is generally only used when other conservative treatments haven't worked.

Your consultant will recommend trying the above conservative treatments for around six months. If by this stage your symptoms have not improved, they may recommend tibialis posterior tendon repair surgery. Ahead of the procedure, they will walk you through everything you need to do before coming to the hospital.

Prepare for a hospital stay

Usually, you will need to stay with us after your operation for one or two nights, giving us time to see how you've recovered from surgery, run X-ray tests, and administer pain relief whenever necessary, along with supporting you to use crutches and give advice regarding your rehabilitation programme. Ahead of your surgery, then, take care to bring any provisions that might be useful during your time with us, such as loose-fitting clothing to stay comfy while you recover, as well as materials to keep you entertained (laptops, books, etc).

Make your home recovery friendly

For the first two weeks after your tibialis posterior tendon repair surgery, your movement will be severely limited, which means that you won't be able to make any trips to the supermarket. So, before coming to the hospital, stock up on all the supplies you might need and have it within easy reach of where you'll be recovering.

If you sleep on the second or third floor, we recommend setting up your recovery space on the ground floor, as this means you'll avoid any unnecessary trips up the stairs as you're healing. Be mindful of removing anything that might be a tripping hazard as well (loose flooring, furniture, general mess, etc).

Stop smoking

If you are a smoker, there is an increased chance of you experiencing breathing and/or heart problems as a result of surgery. It will mean you require more general anaesthetic than normal, which can present certain issues. Your recovery may also not be as effective if you keep smoking afterwards. We therefore recommend that you stop smoking at least a week before your tibialis posterior tendon repair surgery.

Discuss medications with your consultant

Your consultant will discuss medications with you before booking you in for surgery. If you are on any blood thinners, such as aspirin, anti-inflammatories, or warfarin, it may be that you are asked to stop taking them two weeks prior to your surgery. This ensures against any unwanted bleeding during and/or after your surgery.

Food and drink

Eat a healthy balanced diet in the lead-up to your surgery, and avoid alcohol 48 hours before coming to hospital. As always, don't have anything to drink or eat after midnight on the day of your procedure.

There are many different types of surgery that your consultant may recommend. The exact operation you have will be based on factors such as where exactly the damage lies on your tendon and the severity of your problem. Usually, your surgeon will perform one of five main treatments for tibialis posterior tendon repair. In complex cases, further surgeries may be required.

Tibialis posterior tendon repair is mainly performed under general anaesthetic, which means you'll be asleep for the entire operation and won't feel any pain.

Lengthening your Achilles tendon

This procedure involves lengthening your calf muscles, which can prevent flat feet from returning in the future and is particularly useful if you struggle to move your ankle up. Your surgeon will make a small incision on the inner side of your leg over your calf muscle and place a retractor (an instrument used to separate tissues so that deeper areas can be accessed) between your muscles. They can then reach the tissue that covers your muscle fibres (known as your fascia) and carefully cut through it, which allows your muscle to relax and lengthen and means your foot regains its flexibility.

Tendon transfer

In this procedure, your surgeon will take another tendon in your foot and use it as a substitute for your damaged tibialis posterior tendon. The tendon that is commonly transferred is known as your Flexor Digitorum Longus (FDL), which supports the bending of your toes (please note that you will still be able to bend your toes after this procedure). After using special instruments to transfer this tendon to the place where damaged has occurred, your surgeon then makes a cut into your heel bone to move its position, ahead of fixing it in place using metal screws.

Fusion

Used when your flat foot is stiff and/or you have arthritis in the back of your foot, fusion (or arthrodesis) involves realigning your foot, restoring its correct shape, and removing any inflamed tissue caused by arthritis. To do this, your surgeon will make an incision over the area with damaged tissue and, using special instruments, remove the remaining cartilage (smooth tissue that allows joints to glide smoothly between each other).

Eventually, your body 'glues' these joints together, making them one large bone without a joint. Screws will be placed to keep your bone secure and ensure it heals in the right way, which in turn relieves pressure on your tibialis posterior tendon and surrounding joints.

Osteotomy

An osteotomy is a common treatment for problems with your bones, joints, and soft tissue. Your surgeon will make an incision on the outside of your foot, giving them access to your heel bone. They will then cut a portion of your heel bone along a specified angle, ahead of sliding the heel bone towards the inside of your foot and fixing it in place with screws. By making this adjustment, your surgeon changes the shape of your flat foot to create a more normal arch shape, relieving pressure on your affected tendon.

Tenosynovectomy (cleaning your tendon)

This procedure is used when there is swelling and/or damage over the tendon without there being any change to the shape of your foot. Your surgeon makes a small incision over your tibialis posterior tendon and uses tiny surgical instruments to remove any surrounding inflamed tissue. In more severe cases, your surgeon may combine this operation with other treatments that are designed to address your flat foot.

Everyone recovers at a different speed. There is no specific timeframe for when you might return to full strength and range of movement. Generally, full recovery occurs from anywhere between three to six months. How quickly you get back to full can be influenced by a range of factors, such as:

• Your fitness levels
• Your everyday activities
• The nature of your job
• General health
• The type of tibialis posterior tendon repair surgery you have
• Your age

Recovering in hospital

You may feel a bit weary when you wake up from surgery, which is a normal side effect from the general anaesthetic. There might also be some pain, and we will provide you with all the pain relief medication you need, along with managing your dressings. During this time, your consultant may take an X-ray of your heel and ankle to see how you have responded to the surgery.

Before leaving hospital, your foot will be placed in a half plaster (known as a backslab), and we will speak to you about caring for your foot and any gentle physiotherapy exercises that you can do once your backslap comes off after two weeks.

Two days to two weeks after surgery

During this period, it is important that you keep your foot elevated above your pelvis to support the healing process and prevent any infections from developing. You will be given crutches to get around, but we recommend you rest as much as possible and take pain relief medication whenever needed. You'll need to avoid getting the area wet, so take care to shower with a plastic bag wrapped over your foot.

At the two-week stage, you will have your stitches removed at our clinic and your backslap will be replaced with a protective foot brace or splint. Another X-ray may be taken to assess how you have recovered from your tibialis posterior tendon repair surgery.

Two to six weeks after surgery

If you have a job that doesn't require any walking or movement, and you're able to work from home, you may be able to return to work after two weeks - provided you're able to keep your foot elevated. Returning to driving at this stage is only possible if you drive an automatic vehicle and the surgery was on your left foot.

At this point, your physiotherapist will provide you with a series of gentle stretching exercises that prevent your foot and ankle from going stiff and gradually improve the range of motion. You can also increase the amount of walking you do while wearing your protective boot after four weeks. Your consultant will check on you again after six weeks.

Six weeks to three months after surgery

After six weeks, you should be able to walk without crutches in your protective boot. You should also be able to step up your rehabilitation programme during this period. Your physiotherapist will encourage you to move your ankle up and down and side to side at regular intervals, with ankle strengthening exercises starting at around 10 to 12 weeks following surgery. They shall work with you to gradually build up to full exercise and activities when you are ready.

If you drive a manual vehicle, you can return to driving after around three months. You can return to your manual labour job after this period as well. Once your protective boot comes off (usually between two to three months after surgery) you will be encouraged to wear custom-made orthotics to preserve the correct shape of your foot.

Complications can sometimes occur during tibialis posterior tendon repair, but these are extremely rare. Your consultant will speak to you about all the risks of this surgery beforehand, along with answering any questions you might have.

General complications of any operation

• Pain
• Bleeding
• Infection in the surgical wound
• Unsightly scarring
• Blood clots
• Difficulty passing urine
• Chest infection
• Heart attack or stroke

Specific complications of tibialis posterior tendon repair surgery

• Excess bleeding
• Nerve damage
• Infection in bones in your foot
• Weakness of your calf muscles
• Continued pain in your foot and ankle
• Chronic regional pain syndrome (CRPS)
• Prolonged swelling
• Screws or pins become loose, causing pain

When you choose to go private with Circle Health Group, you can expect:

• Flexible appointment times and locations that suit your needs
• The freedom to choose the hospital and consultant that is right for you
• Personalised, consultant-led treatment plans adapted to your specific requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about elbow replacement surgery, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in November 2022. Next review due November 2025.

1. Tibialis Posterior Dysfunction, London Orthopaedics Surgery
2. Posterior Tibial Tendon Dysfunction, OrthoInfo
3. Posterior Tibial Tendon Dysfunction (PTTD), Cleveland Clinic
4. Tibialis Posterior Tendon, Foot Forward Clinic