Biomechanical and Clinical Factors Related to Stage I Posterior Tibial Tendon Dysfunction

Abstract

Posterior tibial tendon dysfunction (PTTD) is a progressive and debilitating condition that is estimated to affect nearly 5 million people in the United States. 7 In the early stages (stage I) of the condition, PTTD is a common running-related injury. 31While the aetiology of PTTD has not been established, it is considered multifactorial in nature and has generally been related to progressive alterations in arch structure, muscular strength, and gait biomechanics. T T BACKGROUND:PTTD is a progressive condition, so early recognition and treatment are essential to help delay or reverse the progression. However, no previous studies have investigated stage I PTTD, and no single study has measured static anatomical structure, muscle strength, and gait mechanics in this population. T T METHODS: Twelve individuals with stage I PTTDand 12 healthy, age-and gender-matched control subjects, who were engaged in running-related activities, participated in this study. Measurements of arch height index, maximum voluntary ankle invertor muscle strength, and 3-dimensional rearfoot and medial longitudinal arch kinematics during walking were obtained. T T RESULTS:The runners with PTTD demonstrated significantly lower seated arch height index (P = .02) and greater (P = .03) and prolonged (P = .05) peak rearfoot eversion angle during gait, compared to the healthy runners. No differences were found in standing arch height index values (P = .28), arch rigidity index (P = .06), ankle invertor strength (P = .49), or peak medial longitudinal arch values (P = .49) between groups. T T CONCLUSION:The increased foot pronation is hypothesized to place greater strain on the posterior tibialis muscle, which may partially explain the progressive nature of this condition.

Self‐reported social and activity restrictions accompany local impairments in posterior tibial tendon dysfunction: a systematic review

“…Combined isometric forefoot adduction and subtalar inversion strength in plantar flexion was reported in three studies [22, 24, 28]. Pooled data from two studies that measured strength in 90 degrees of knee flexion [22, 24] revealed a moderate deficit (based on an SMD value of − 1.19) in PTTD compared to controls (MD − 0.27 N/kg) (Fig.…”

“…2). The other study measured forefoot abduction and subtalar inversion strength in full knee extension [28] and showed no difference (MD 0.01 N/kg). It was excluded from the pooled analysis due to heterogeneity of testing position.…”

“…There was a large SMD for AHI taken in a seated position, yet the Arch Rigidity Index (ratio of standing AHI to seated AHI) was not different between PTTD and control groups (Fig. 3) [28].

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Quiste sinovial en el tendón del músculo tibial posterior.Caso clínico, consideraciones biomecánicas y revisión bibliográfica

“…La causa del fracaso quirúrgico, incluso con una extirpación en su totalidad, vendría dada por no reparar la causa etiológica, es decir, por no reparar la herniación de la vaina tendinosa, causante de la extravasación de mucina, origen del ganglión y la alteración funcional que la produjo. En este sentido, estudios anatomopatológicos demuestran que la disfunción del tendón del músculo tibial posterior, como el caso presentado, puede producir tendinitis 15,16 , tendinosis y fibrosis con o sin rotura de dicho tendón 17 . Con mucha frecuencia la causa patomecánica de la hernia tendinosa (y consiguientemente del quiste sinovial) está muy alejada del lugar donde se produce esta lesión paratumoral por lo que un adecuado tratamiento ortopodológico y/o rehabilitador son determinantes para evitar recidivas postquirúrgicas.…”

Sports Injuries of the Ankle

“…Athletes with a clear pes planovalgus or with a forefoot abduction are prone to place greater strain on the muscle (Rabbito et al 2011 ). Posteromedial palpation will reveal tenderness, discrete swelling and occasionally crepitus.…”