Dr Ling 02 9650 4782       Dr Lunz 02 9650 4835
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  • Dr Jeff Ling - Sydney Foot & Ankle Surgeon
  • Foot & Ankle Surgeon Sydney
  • Dr David Lunz - Foot & Ankle Surgeon

Adult Acquired Flatfoot

(Posterior Tibial Tendon Dysfunction)

Dr Jeff Ling & Dr David Lunz

Sydney Orthopaedic Specialists: Foot & Ankle Institute

The most commonly torn tendon in the adult foot and ankle population is the posterior tibial tendon. This is the tendon that goes down the inside of the ankle, holds up your arch, and allows you to go up on your toes and to push off when you walk. This tendon is commonly torn in women around 50-60 years of age and leads to a progressive flatfoot deformity. Many patients who develop a posterior tibial tendon tear have a longstanding flatfoot, and then with repetitive loads over the years, the tendon finally gives out. Once the tendon tears, the ligaments connecting the bones in the foot start to stretch out and the foot becomes progressively flatter. Patients typically complain of an inability to walk on their toes. They walk with their foot and toes pointed outwards. They complain of pain and swelling on the inside of their ankle that makes walking any distance difficult.

Non-operative treatment of posterior tibial tendon dysfunction is the use of a brace or orthotic to stabilise the ankle while the tendon heals. This is only effective in patients whose foot is not too flat and very early on in the disease. The vast majority of patients with posterior tibial tendon dysfunction will undergo surgical intervention. The surgery consists of replacing your posterior tibial tendon with one of your toe tendons (Do not worry though, as you have two tendons to each of your toes and you will still be able to move your toes) and restoring your arch with some combination of bony procedures. We restore your arch by cutting your heel bone and shifting it over and sometimes using a metal plug to prop up your arch as well. Sometimes we will cut and shift or fuse some of the joints on the inside of your midfoot in order to stabilise your arch. The exact combination of procedures required is determined by your x-rays, your MRI, and of course, your clinical exam.

Adult Flatfoot Reconstruction

The first stage is to treat the posterior tibial tendon on the inside of the ankle. This is done usually by trimming back the torn posterior tibial tendon and transferring the long tendon from your lesser toes, called FDL. You are still able to move your toes up and down because there are two tendons in each of your toes, and patients do not notice that we have transferred this tendon.

The rest of the procedure involves restoring your arch. We do this by doing a medialising calcaneal osteotomy. This procedure helps to restore your arch without fusing any of the bones under your foot. Sometimes, additional procedures such as cutting and wedging one of the inner bones of the midfoot – the medial cuneiform - are performed to further stabilise your arch. The goal of this procedure is to restore your arch, relieve the pain associated with the torn tendon, and return you to full function.

Postoperatively, the initial 6 weeks involves non-weightbearing in a cast, whilst we wait for the tendon transfer and bony cuts to heal. Thereafter, we transition you to a boot and allow you to weightbear. By the third month,you can transition back to normal shoes but the entire recovery takes 6 months.


Flatfoot Surgery Sydney

The posterior tibial tendon attaches the calf
muscle to the bones on the inside of the foot.

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X-ray image flatfoot reconstruction

Any surgical or invasive procedure carries risks. The information provided here is for general educational purposes only. Patients should discuss their particular situation with the doctors of Sydney Orthopaedic Specialists: Foot & Ankle Institute.