Medical Edge Newspaper Column

Treatment Options for Torn Tendon

April 17, 2008
Dear Mayo Clinic:
I was recently diagnosed with a torn tendon in my right foot. An orthopedic surgeon has recommended surgery, but I understand the recovery is difficult. As I live alone, I would have to go to a nursing home, and then I would be on crutches for four to six weeks. Another surgeon recommended a brace for four to five months to see if the tendon heals. Do I have options other than surgery if the tendon does not heal?

Answer:
Your foot contains many tendons — the thick, fibrous cords that attach muscle to bone. You don't say which one you've torn. But, the tendon that commonly causes problems in a person's foot is the posterior tibial tendon. This tendon begins in your calf, runs down along the inside of your ankle and attaches to bones in the middle of your foot. It provides the main support for your foot's arch.

A torn posterior tibial tendon can lead to foot pain and swelling, loss of your arch, weakness in your foot and inability to stand on your toes. If left untreated, eventually it can result in other foot and leg problems, such as inflammation and pain in the ligaments in the soles of your foot (plantar faciitis), tendinitis in other parts of your foot, shin splints, pain in your ankles, knees and hips and, in severe cases, arthritis in your foot. So, effective treatment is crucial. But, there's no simple fix.

In a situation like yours, when managing recovery after surgery would be difficult, the recommendation to try a brace first seems reasonable. A custom-made foot brace that extends above your ankle can take the stress off the tendon, relieving symptoms and making it easier to walk. In some cases, wearing the brace allows for healing, and no further treatment is needed.

If the tendon doesn't heal with the brace, however, surgery is still an option to correct the problem. Several surgical approaches may be considered. Generally, they involve realigning or fusing bones together to stabilize the foot. The specific type of surgery you would need depends on your condition. All of the surgical treatments for a torn posterior tibial tendon require a period of recovery afterward that includes immobilizing the affected foot and not putting any weight on it.

Keep in mind, though, that surgery isn't required, even if the tendon doesn't heal. Most people can wear a brace long-term without causing complications or further damage to the tendon. If it relieves pain and other symptoms, and you don't mind wearing it, there's no reason you can't use a brace indefinitely. Many people who prefer not to undergo surgery choose this option.

If the tendon does heal with the brace, consider using arch supports in your shoes long-term to help prevent future tendon damage. Also, in some cases, excess weight can make foot problems worse. So, if you're overweight, weight loss may help prevent further tendon damage, too.

— Norman Turner III, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minn.