Posterior Tibial Tendon Dysfunction: Difference between revisions
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<div class="noeditbox">Welcome to [[Vrije Universiteit Brussel Evidence-based Practice Project|Vrije Universiteit Brussel's Evidence-based Practice project]]. This is a wiki created by and for the students in the Rehabilitation Sciences and Physiotherapy program of the Vrije Universiteit Brussel, Brussels, Belgium. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div> <div class="editorbox"> | |||
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== Definition/Description == | |||
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
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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. <ref name="Kulig" /> | 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 <ref name ="Johnson">Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Rel Res.1989;239:196-206</ref>: | 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 I: Posterior tibial tendon intact and inflammed, no deformity, mild swelling | ||
*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 | *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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4. Diabetes<ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | 4. Diabetes<ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | ||
5. Inflammatory arthritis <ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | 5. Inflammatory arthritis <ref name="Kohls-Gatzoulis" /><ref name="Kulig" /> | ||
6 Obesity<ref name="Kulig" /> | 6 Obesity<ref name="Kulig" /> | ||
== Differential Diagnosis == | == Differential Diagnosis == | ||
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1. Rupture of spring ligament<ref name="Geideman">Geideman WM, Johnson JE. Posterior tibial tendon dysfunction. JOSPT.2000;30:68-77</ref> | 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<ref name="Geideman" /> | 2. Degenerative arthritis<ref name="Geideman" /> | ||
3. Posttraumatic tarsometatarsal joint arthritis<ref name="Geideman" /> | 3. Posttraumatic tarsometatarsal joint arthritis<ref name="Geideman" /> | ||
4. Inflammatory arthritis<ref name="Geideman" /> | 4. Inflammatory arthritis<ref name="Geideman" /> | ||
5. Peripheral neuropathies <ref name="Geideman" /> | 5. Peripheral neuropathies <ref name="Geideman" /> | ||
== Resources == | == Resources == | ||
Revision as of 22:33, 8 November 2010
Original Editor - Brian Duffy
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Original Editors
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Search Strategy[edit | edit source]
add text here related to databases searched, keywords, and search timeline
Definition/Description[edit | edit source]
add text here
Epidemiology /Etiology[edit | edit source]
add text here
Characteristics/Clinical Presentation[edit | edit source]
add text here
Differential Diagnosis[edit | edit source]
add text here
Examination[edit | edit source]
add text here
Medical Management (current best evidence)[edit | edit source]
add text here
Physical Therapy Management (current best evidence)[edit | edit source]
add text here
Key Research[edit | edit source]
add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)
Resources
[edit | edit source]
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Clinical Bottom Line[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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Extension:RSS -- Error: Not a valid URL: Feed goes here!!|charset=UTF-8|short|max=10
References[edit | edit source]
see adding references tutorial.
Clinically Relevant Anatomy
[edit | edit source]
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]
References will automatically be added here, see adding references tutorial.
- ↑ 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
