Advice after your nerve block for surgery
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What is Tibialis Posterior Insufficiency and how is it caused?
Tibialis Posterior Insufficiency (TPI) is the most common cause of a flat foot or “dropped arches” in adults, and typically affects women in their 40s or 50s. In this condition, the Tibialis Posterior tendon, which acts as a “guy rope” to hold up the arch of the foot, suffers wear and tear damage, and stretches or ruptures. This allows the arch of the foot to drop further, and also causes inflammation and pain in the tendon.
What are the symptoms?
- The arch of the foot drops
- Swelling and pain on the inner ankle / inside of foot
- Pain on standing or after walking for long periods
- Difficulty with footwear
What treatments are available?
The initial treatment is usually insoles or shoe modifications and monitoring to ensure significant stiffness does not develop. Anti-inflammatory/pain relief medication, weight loss, modification of activities and change of footwear may also help. If non-operative measures fail, then surgery may be necessary to reconstruct the shape of the foot.
What does the operation involve?
Prior to the operation you will be seen in the Pre-assessment clinic or receive a phone call assessment. This is to ensure that you are fit to have surgery.
The operation is carried out under general anaesthesia, often supplemented with a local anaesthetic block for pain relief. It involves an osteotomy (cutting and moving sideways) of the heel bone, a tendon transfer and ligament reconstruction. A small implant may also be placed just below the ankle, which is removed approximately 6 months later.
Your risk of developing a deep vein thrombosis will be assessed and prophylactic treatment will be given as required.
What about pain?
Whilst you are in hospital you will be monitored and the medical staff will give you pain relief as required and prescribed. You will be given pain relief medication to take home. Advice regarding this will be given by the nursing staff before you leave hospital.
How long does recovery take?
Most patients remain in hospital for 1–2 days after the operation. You will have a temporary cast below the knee, and will be required to non-weight bear with crutches.
Your temporary cast and wound dressings will be changed and stitches removed (if applicable) at your follow up appointment approximately 10 days following your surgery.
After this stage a full below-knee cast will be applied, but you will not be allowed to weight-bear at that stage. You must keep this cast dry. The length of time until weight-bearing is permitted varies with the operative technique used, and you should ask your surgeon about this before the operation.
After 6 weeks, you will be allowed “protected weight-bearing” in a special removable walker-boot. You are normally able to fully weight bear at 10 to 12 weeks following your operation.
Swelling is quite common after foot and ankle surgery and this is best managed by elevating the foot at regular intervals. You are advised to elevate the operated foot/ankle on a pillow every night and during the day on three separate occasions, e.g., 11am, 3pm and 6pm for about one hour each time.
When can I drive?
Patients having had the left ankle operated on will be able to drive an automatic car within 2-3 weeks (short distances only to avoid swelling). Those who have had an operation on the right side will be able to drive after about 12 weeks.
You are advised not to fly after surgery for six weeks (short haul) and 12 weeks (long haul).
When can I return to work?
If you have a desk job, you should be able to return to work if you are able to elevate your leg during the day after about 2-4 weeks. If you do manual work, you will need at least 12 weeks off work.
Golf, walking and even running short distances are all possible after a successful reconstruction.
What are the possible complications?
- Infection
- Prolonged swelling
- Nerve or blood vessel injury
- Stiffness of the ankle
- Deep vein thrombosis (clot in vein)
- Pulmonary embolus (clot in lung)
- Delayed union or Non-union (failure of bone to join)
- Malunion (bone joins in imperfect position)
- Post-operative pain (including complex regional pain syndrome)
- Residual or recurrent deformity
- Over-correction of deformity (pes cavus)
The above complications are rare but can occur.
Useful Contacts
Heatherwood Hospital:
- Orthopaedic pre assessment 0300 614 7778 / 0300 614 7147
- Arthroplasty Nurse Heatherwood 07789927177
- Nurses Station Treetops Heatherwood 0300 614 4175
- Physio/OT Office Treetops Heatherwood 0300 614 4178
Frimley Park Hospital:
- Frimley Park Physiotherapy 07570 974390
- S2 Elective Ward Frimley 0300 613 3781 / 0300 613 3783
- Elective Helpline Frimley 0300 613 2556
Wexham Park Hospital:
- Ward 1 Wexham Park 0300 615 3010 / 0300615 3012
- Outpatient Physio Wexham 0300 615 3501 / 0300615 3500
- Wexham Park Physiotherapy 07717 199851
Contact us
If you have any queries relating to this information, please contact the Orthopaedics service.
About this information
Service:
Orthopaedics
Reference:
N/024
Approval date:
13 February 2024
Review date:
1 January 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.