Schilling tendon procedure

Schilling Tendon Procedure is a surgical technique used in the treatment of certain foot deformities, particularly those involving the Achilles tendon and the posterior tibial tendon. This procedure is often indicated for conditions such as flatfoot, posterior tibial tendon dysfunction (PTTD), and other deformities that result in an abnormal gait or foot structure. The Schilling Tendon Procedure aims to correct these deformities by transferring tendons, thereby improving the patient's foot alignment and function.

Indications

The primary indication for the Schilling Tendon Procedure is the presence of a foot deformity that has not responded to conservative treatments, such as orthotics, physical therapy, or bracing. Specific conditions that may warrant this procedure include:

• Severe flatfoot deformity
• Posterior tibial tendon dysfunction (PTTD) that has progressed to stage II or beyond
• Certain cases of Achilles tendon pathology where alteration of foot dynamics is necessary

Procedure

The Schilling Tendon Procedure involves the transfer of one or more tendons to different insertion points on the foot. The specific tendons involved and the details of the transfer depend on the patient's condition and the deformity being corrected. Generally, the procedure follows these steps:

1. An incision is made over the affected area to expose the tendons and bones involved.
2. The tendon(s) to be transferred is identified and mobilized.
3. The recipient site is prepared, which may involve creating a new insertion point on a bone.
4. The tendon is transferred to its new location and secured, often with sutures or bone anchors.
5. The incision is closed, and the foot is immobilized in a cast or boot to allow for healing.

Recovery

Recovery from the Schilling Tendon Procedure varies depending on the extent of the surgery and the patient's overall health. Initial recovery typically involves several weeks of non-weight bearing to protect the tendon transfer, followed by a gradual return to weight-bearing activities. Physical therapy is an essential component of the recovery process, focusing on restoring strength, flexibility, and function to the affected foot.

Risks and Complications

As with any surgical procedure, the Schilling Tendon Procedure carries risks and potential complications, including:

• Infection
• Nerve damage
• Blood clots
• Failure of the tendon transfer
• Continued pain or deformity

Conclusion

The Schilling Tendon Procedure is a valuable surgical option for correcting certain foot deformities and improving patient mobility and quality of life. As with any surgical intervention, careful patient selection and adherence to postoperative care protocols are critical to achieving the best outcomes.