Painful Flatfoot / Posterior Tibial Tendonitis
Flat feet is a rather common occurrence within the general population.
Even in patients without pain associated with their flat feet, I always
recommend an orthotic, or an arch support. Wearing an orthotic can help
to protect the foot from the development of future problems related to flat
feet. One of these problems is posterior tibial tendonitis.
The posterior tibial tendon lies on the inside of your ankle.
It serves as an inverter (turns the foot in) of the foot.
It also helps to support the arch of the foot. In someone with flatfeet,
this tendon must work harder to support the arch. With time this tendon
can become “worn down” and become inflamed. One may notice that over time
their feet have become “flatter.” This occurs because the tendon has stopped
doing its job in supporting the arch. It is important to note that posterior
tibial tendonits can occur in patients with normal arches, but much less commonly
than patients with flat feet.
Some of the ways we treat posterior tibial tendonitis is with anti-inflammatory medicines (NSAIDs),
a period of casting or bracing, and activity modification.
Long term treatment of this condition involves use of an orthotic to help
support the arch and give the tendon some rest. If these modalities fail,
then surgery may be indicated.
Surgery for this condition can become very extensive.
The type of procedure chosen depends on the degree of deformity as
well as the presence of arthritis. If there is coexistent arthritis
in any of the joints involved, then fusion surgery would be indicated
(see section on having fusion surgery). Otherwise, surgery would essentially consist of two parts.
The first part involves debridement or removal of the diseased posterior tibial tendon
followed by transfer of another tendon in the foot (usually one of the tendons to the small toes)
to help take its place. The second part involves actually cutting the heel bone (called an osteotomy),
then shifting it over to help create a better arch. The osteotomy is held in place by a metal screw.
Immediate post-operative recovery involves four to six weeks in a cast,
followed by 4-6 weeks of physical therapy. Expect full recovery and return to activity by 4-6 months.