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Hyperlife Medical Centre

010 020 5050 | 80 Van Bergen St,
Brackenhurst, Alberton

Morningside Mediclinic

011 883 1719 | Rivonia Rd, Hill Rd,
Sandton, 2057

OSTEOTOMY OF THE TIBIA

  • Type of Procedure: In-patient, one to two-day hospital stay
  • Length of Procedure: 2 hours
  • Anesthesia:General anesthesia with nerve block

Osteotomy of the tibia

What is it?

This is an operation which is designed to change the position of the leg bone (the tibia). Sometimes the smaller bone in the leg (the fibula) is also included in the surgery.

This operation is performed to correct deformity of the leg, foot or ankle, but can also be used to assist with treatment for arthritis of the ankle.

To perform the osteotomy, the bone is cut (an osteotomy) and the position of the leg is changed. The cut can be made either with or without a bone graft which is obtained from the bone bank or from the hip.

There is a slight difference in the speed of healing when a bone graft is inserted, but if no bone graft is used, the leg is typically 6-10 mm shorter.

To hold the new position of the tibia, a metal plate and screws are inserted, which are usually permanent.

Once the bone cut (osteotomy) has healed, they do not need to be in any longer, but we usually leave them in to save an additional operation.

Postoperative recovery: General factors

  • You will not be walking on the leg for 8-10 weeks, but this depends on how quickly your bone starts to heal.
  • To stay off your foot, you will need to use crutches, a walker, a wheelchair or a scooter type device called a roll-about.
  • There will be a hard plaster bandage applied to the leg for two weeks after surgery.
  • Your first follow up visit will be approximately 2 weeks to remove the stitches.
  • I will usually apply a removable boot OR a short leg below the knee cast to be worn for another 6 weeks after surgery.
  • If the surgery is on your right ankle, you should be able to drive an automatic vehicle at 6 weeks. If the surgery is on the left foot, you may drive between 8-10 weeks.
  • You may begin to walk without the boot at about 12-16 weeks, depending upon your level of discomfort, and bone healing.
  • Physical therapy is helpful to regain the strength and movement of the ankle.
  • You should plan to use a physical therapist for about 2 months 2 months.
  • An orthotic arch support may be important for your recovery however this is not always necessary and you will be referred to an appropriate orthotist to have these custom made with a computerized pressure plate.
  • You should wear a stiff soled shoe for 1 to 2 months.
  • There will some soreness and aching for about 6-9 months after surgery
  • There will be moderate swelling of the ankle for about 12 months.
  • You will continue to improve your strength and movement for about 18 months after surgery.
  • You may experience a variety of sensations whilst in the cast consisting of sharp shooting, dull aches, electric shocks, throbbing, sensation of itching and these are all normal and you should not panic.
  • You will also be placed on DVT prophylaxis as there is a risk of blood clots shooting to the lungs with this procedure for a period of 6 weeks.

Specific post-operative recovery

  • Foot is wrapped in a below knee splint with bandages if swelling is a concern, alternatively you will be placed in a below-knee cast.
  • Elevate the leg on some pillows when awake however when sleeping elevate the base of the bed with 2 bricks or thick books so that the limb does not fall off the pillow at night and you wake up swollen.
  • Apply ice packs.
  • Take pain and DVT prophylaxis medication as prescribed.
  • Expect numbness in foot 4-12 hours, followed by pain for usually one more day.
  • Do not allow foot to hang down and under no circumstances bare weight.
  • If you are travelling, move the toes as much as possible to stimulate the calf muscle however travel during this time is not advisable.
  • First follow-up in the office.
  • Wound/cast inspection for any possible complications or irritable areas.
  • Application of below-knee cast for 6-8 weeks if patient previously had a splint.
  • Strict non-weightbearing in cast with post-operative shoe and crutches initially to pain and swelling.
  • Can allow foot to hang down at 3 weeks provided no pain and swelling occurs.

CAST REMOVED

  • CT scan is taken to assess for fusion.
  • Cast is removed by my dressing Sister and wound inspected.
  • If incision is dry and completely healed, swimming is permitted for rehabilitation purposes taking care to not jump in the pool or apply any unnecessary force.
  • Gentle exercise on bicycle or swimming in a pool with a flipper permitted preferably guided by physiotherapist.
  • At this stage removable Moon boot is fitted and foot is prevented from taking excessive load and must be used for 6 weeks for any form of walking however patient does not need to sleep with this boot.
  • 30lbs/13.63kgs body weight on the leg is allowed 5 minutes twice a day when washing/bathing.
  • Control x-ray is taken.
  • If swelling is problematic you may require the use of a compression sock.
  • Start physical therapy under supervision with my protocols and this will focus on scar desensitisation and joint motion mostly.
  • More vigorous exercise with Biokineticist for the next 8-12 weeks in order to achieve strength within 10% of the unaffected side hence clearing you for return to sport.
  • Can discontinue boot at this stage and use a shoe with a supportive sole and a slight heel lift (heel cup) inside the sole of the shoe .
  • May require gait analysis and custom orthotics to be made on an individual basis in order to assist with rehabilitation.
  • Followup in my consultation rooms.
  • Control x-ray is taken.
  • Photographs and video taken of range of motion and strength.
  • Final followup in my consultation rooms.
  • Photographs are taken of range of motion and strength.
  • Control x-ray is taken.
  • Patient outcome score taken.
  • Swelling and residual weakness can often be expected up until this point.
  • Patient is usually discharged at this stage.
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