Tibialis posterior tendon debridement
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In the appropriately selected patient a tibialis posterior tendon debridement and repair will provide a very effective (and rapid) means of both halting symptoms and also possibly progression of the tendon degeneration. It is used in the main for patients with symptomatic grade 1 tendinosis, according to the classification system of Johnson & Strom. In other words no functional lengthening of the tendon and with the ability to perform a single heel rise still preserved.
A stripping of the paratenon, targeted, limited incisions into all areas of degenerative change and excision and repair of degenerative cysts and tears is followed by a variable period of non-weight-bearing in cast. This may be as short as two weeks, followed by three to four weeks in a post-operative boot and progressively loading the tendon.
A return to full function is the norm in patients with non-inflammatory conditions as the cause.
Late deterioration is in my experience an uncommon event after an initially successful surgical intervention.
Most cases of grade 1 tendinosis however will settle with conservative management using a long post-operative boot and semi-rigid functional foot orthotic as long as presentation is early enough.
The fuller reconstruction of the degenerate, lengthened and defunctioned tibialis posterior tendon is covered on OrthOracle with techniques including FDL transfer with Calcaneal osteotomy and arthroresis screw https://www.orthoracle.com/library/pes-planus-correction-fdl-transfer-calcaneal-osteotomy-wright-bioarch-arthroresis-screw/ as well as FDL transfer with Calcaneal osteotomy and spring ligament reconstruction https://www.orthoracle.com/library/tibialis-posterior-reconstruction/
Author:Mark Herron FRCS.
Institution: The Wellington Hospital, London, UK.