The procedure is usually done under a general anesthetic with an injection in the foot to numb it and reduce pain after the operation. In most cases, you will stay overnight in a hospital. During surgery, three incisions (cuts) are made in the foot and the
painful, damaged tendon on the instep is removed and replaced with another tendon (the flexor digorum longus tendon or FDL). This is
known as tibialis posterior tendon reconstruction.
A procedure known as calcaneal osteotomy is usually carried out at the same time; this involves making a cut in the heel bone so that it can be repositioned and fixed with a metal screw. Repositioning the heel bone helps improve support to the foot arch. The surgeon may also place a metal plate at the top of the foot to increase the arch. You will be able to discuss these procedures with your specialist beforehand.