Posterior Tibial Tendon Dysfunction: Difference between revisions
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== Interventions<br> == | == Interventions<br> == | ||
The key to a successful outcome is early detection of the dysfunction. Orthoses use, static stretching of gastocnemius and soleus muscle, and concentric/eccentric training of the posterior tibialis have demonstrated success. As per Kulig et al, orthoses use and eccentric training demonstrate the most improvement over a 12 week period. < | The key to a successful outcome is early detection of the dysfunction. Orthoses use, static stretching of gastocnemius and soleus muscle, and concentric/eccentric training of the posterior tibialis have demonstrated success. As per Kulig et al, orthoses use and eccentric training demonstrate the most improvement over a 12 week period. <ref name="Kulig" /> | ||
== Classification <br> == | == Classification <br> == | ||
As per Johnson and Strom: < | As per Johnson and Strom <ref name ="Johnson">Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Rel Res.1989;239:196-206</ref>: | ||
*Stage I: Posterior tibial tendon intact and inflammed, no deformity, mild swelling | |||
*Stage II: Posterior tibial tendon dysfunctional, acquired pes planus but passively correctable, commonly unable to perform a heel raise | |||
*Stage III: Degenerative changes in the subtalar joint and the deformity is fixed *Stage IV ( Myerson): Valgus tilt of talus leading to lateral tibiotalar degeneration | |||
== Risk Factors == | == Risk Factors == | ||
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2. Pes planus<ref name="Kohls-Gatzoulis" /> | 2. Pes planus<ref name="Kohls-Gatzoulis" /> | ||
3. HTN <ref name="Kohls-Gatzoulis" />< | 3. HTN <ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | ||
4. Diabetes<ref name="Kohls-Gatzoulis" /> < | 4. Diabetes<ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | ||
5. Inflammatory arthritis <ref name="Kohls-Gatzoulis" />< | 5. Inflammatory arthritis <ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | ||
6 Obesity < | 6 Obesity<ref name="Kulig" /> | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
1. Rupture of spring ligament < | 1. Rupture of spring ligament<ref name="Geideman">Geideman WM, Johnson JE. Posterior tibial tendon dysfunction. JOSPT.2000;30:68-77</ref> | ||
2. Degenerative arthritis < | 2. Degenerative arthritis<ref name="Geideman" /> | ||
3. Posttraumatic tarsometatarsal joint arthritis < | 3. Posttraumatic tarsometatarsal joint arthritis<ref name="Geideman" /> | ||
4. Inflammatory arthritis < | 4. Inflammatory arthritis<ref name="Geideman" /> | ||
5. Peripheral neuropathies < | 5. Peripheral neuropathies <ref name="Geideman" /> | ||
== | == Resources == | ||
Myerson MS. Adult acquired flat foot deformity. J Bone Joint Surg.1996;45A:780-92 | |||
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | ||
Revision as of 15:36, 13 December 2009
Original Editor - Brian Duffy
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Clinically Relevant Anatomy
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The posterior tibial tendon runs posterior to the medial malleolus inserting into the navicular tuberosity and the plantar aspect of the tarsus. It is the primary stabilizer of the medial longitudinal arch, aiding in mid and hind foot locking during ambulation. If compromised, a resulting pes planus foot may develop and place greater stress on the surrounding ligaments and soft tissue[1]
Mechanism of Injury / Pathological Process
[edit | edit source]
Once thought to be a tendonitis, it is now commonly accepted the process is one of tendon degeneration or tendinosis. A poor blood supply has been identified as well as mechanical factors such as peroneal brevis overactivity or a pes planus foot. The later will gradually place increased stress to the posterior tibial tendon causing early degeneration. Trauma ( ankle sprain, fracture) may also can initiate the process[1]
Clinical Presentation[edit | edit source]
1. Pain/swelling behind medial malleolus and along medial longitudinal arch
2. Change in static/dynamic foot ( pes planus)
3. Limited walking ability
4. Impaired balance
5. Impaired MMT PF/IV
6. Difficulty/inability to perform unilateral heel raise. Limited calcaneal inversion upon ascent
7. Impaired subtalar mobility
Diagnostic Procedures[edit | edit source]
The diagnosis of posterior tibial tendon dysfunction can be made clinically based on history and objective testing. Radiographs may be beneficial for assessing degree of deformity and degenerative changes, if present. 1
Outcome Measures[edit | edit source]
Foot Functional Index (FFI)[2]
Interventions
[edit | edit source]
The key to a successful outcome is early detection of the dysfunction. Orthoses use, static stretching of gastocnemius and soleus muscle, and concentric/eccentric training of the posterior tibialis have demonstrated success. As per Kulig et al, orthoses use and eccentric training demonstrate the most improvement over a 12 week period. [2]
Classification
[edit | edit source]
As per Johnson and Strom [3]:
- Stage I: Posterior tibial tendon intact and inflammed, no deformity, mild swelling
- Stage II: Posterior tibial tendon dysfunctional, acquired pes planus but passively correctable, commonly unable to perform a heel raise
- Stage III: Degenerative changes in the subtalar joint and the deformity is fixed *Stage IV ( Myerson): Valgus tilt of talus leading to lateral tibiotalar degeneration
Risk Factors[edit | edit source]
1. Middle aged women[1]
2. Pes planus[1]
5. Inflammatory arthritis [1][2]
6 Obesity[2]
Differential Diagnosis[edit | edit source]
1. Rupture of spring ligament[4]
2. Degenerative arthritis[4]
3. Posttraumatic tarsometatarsal joint arthritis[4]
4. Inflammatory arthritis[4]
5. Peripheral neuropathies [4]
Resources[edit | edit source]
Myerson MS. Adult acquired flat foot deformity. J Bone Joint Surg.1996;45A:780-92
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ.2004;329:1328-1333.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Kulig K, Reischi SF, Pomrantz AB, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther.2009;89:26-37.
- ↑ Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Rel Res.1989;239:196-206
- ↑ 4.0 4.1 4.2 4.3 4.4 Geideman WM, Johnson JE. Posterior tibial tendon dysfunction. JOSPT.2000;30:68-77
