The Effect of Posterior Tibial Tendon Dysfunction on Hindfoot Kinematics

Niki, Hisateru; Ching, Randal P.; Kiser, Patti; Sangeorzan, Bruce J.

doi:10.1177/107110070102200404

Cited by 102 publications

(65 citation statements)

References 41 publications

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“…1), 5,22 which applied compressive forces to the tibia and fibula and tensile forces to the tendons. The frame was made of acrylic to minimize interference with the Fastrak 3D electromagnetic motion tracking system (Polhemus, Colchester, VT).…”

Section: Methodsmentioning

confidence: 99%

“…20 Attenuation of ligaments and tendons followed by cyclic axial loading has been used to simulate progressive development of soft tissue laxity. 5,16,21 Deland et al 20 recently reported MRI data showing which ligaments become attenuated in adult acquired flatfoot. The involved ligaments are the superomedial and inferomedial calcaneonavicular, talocalcaneal interosseous, plantar naviculocuneiform, plantar first metatarsocuneiform, and anterior superficial deltoid ligaments.…”

mentioning

confidence: 99%

“…12 Much research has been devoted to creating and testing cadaveric flatfoot models. 5,6,[13][14][15][16] However, we are unaware of any models that have examined the effects of Achilles tendon contracture. Furthermore, many cadaveric models utilize substantial sectioning of ligaments and tendons to create the deformity.…”

mentioning

confidence: 99%

“…The treatment of pes planus is not well-standardized 3,4 and may involve immobilization, orthoses, and surgical correction. [2][3][4][5] Flatfoot deformity involves loss of the medial longitudinal arch of the foot, in addition to forefoot abduction and hindfoot eversion. 5,6 Many severe or longstanding cases are associated with Achilles tendon contracture.…”

mentioning

confidence: 99%

“…[2][3][4][5] Flatfoot deformity involves loss of the medial longitudinal arch of the foot, in addition to forefoot abduction and hindfoot eversion. 5,6 Many severe or longstanding cases are associated with Achilles tendon contracture. 2,[7][8][9] The presence of a shortened Achilles with the flatfoot deformity has been noted for decades.…”

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confidence: 99%

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Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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Flatfoot deformity is characterized by loss of the medial longitudinal arch, forefoot abduction, hindfoot eversion, and often Achilles tendon contracture. Our objectives were to validate a cadaveric flatfoot model that involves selective ligament attenuation and to determine if Achilles tendon overpull is associated with increased pes planus severity. We measured the three-dimensional (3D) orientation of the bones of interest in the unloaded, loaded, and Achilles tendon overpull conditions. A flatfoot model was created by attenuating ligaments involved in the pes planus deformity followed by cyclic axial loading, and bone orientations were acquired in the three conditions. Significant differences seen between normal feet and flat feet were consistent with those seen with the pes planus deformity. The first metatarsal dorsiflexed and abducted relative to the talus. The navicular abducted relative to the talus. The calcaneus everted relative to the tibia. The talus plantar flexed and adducted. Achilles overpull resulted in first metatarsal-to-talus dorsiflexion and navicular-to-talus abduction. Thus, selective ligament attenuation followed by cyclic axial loading can create a cadaveric flatfoot model consistent with the in vivo deformity. Longitudinal arch depression, hindfoot eversion, talonavicular joint abduction, forefoot abduction, and talar plantar flexion were seen. Simulated Achilles tendon contracture increased the severity of the deformity, particularly in arch depression and forefoot abduction.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Blackman

Blevins

Sangeorzan

et al. 2009

Journal Orthopaedic Research

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The geometric architecture of the subtalar and midtarsal joints in rheumatoid arthritis based on magnetic resonance imaging

Woodburn¹,

Udupa²,

Hirsch³

et al. 2002

Arthritis & Rheumatism

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Objective. To compare in vivo the 3-dimensional (3-D) geometric architecture of the subtalar and midtarsal joints in normal and rheumatoid arthritic (RA) feet, using magnetic resonance imaging (MRI) analysis.Methods. MRI was performed on 23 patients with RA, all of whom had disease activity in the subtalar and/or midtarsal joints. Image processing techniques were used to create 3-D reconstructions of the calcaneus (C), cuboid (c), navicular (N), and talus (T) bones. Twenty-four standard architectural parameters were measured from the reconstructions and were compared with data from 10 normal subjects. These parameters defined both 3-D distance and angular relationships among the 4 bones studied. Pattern classification techniques were used to establish a geometric architecture foot profile for the RA patients. The degree of individual patient fit to the new RA foot profile and to profiles for normal, pes planus, and pes cavus foot types was derived. Logistic regression was used to examine the relationship of foot architecture to inflammatory disease characteristics and physical examination variables.Results. Subtalar or midtarsal pain was reported by all 23 patients, and 22 of the 23 patients presented with >1 clinical feature of pes planovalgus deformity. In 21 patients, ultrasonography revealed synovitis at >1 tarsal joint or surrounding tendon. In the RA group, the normalized distances between the geometric centroids were significantly closer for bone pairs Cc and cT and significantly distracted for bone pair CN compared with the distances in normal subjects. In RA patients (versus normal subjects), the angles subtended at the bone centroids were significantly decreased in 3 bone groups (CNc, TCN, and TNc) and significantly increased in 3 bone groups (CcN, CcT, NTc). The angles formed between the major principal axes of bone pairs CT and cT were significantly increased in RA patients compared with those in normal subjects. Pattern classification defined 11 RA feet as having normal structure and 12 as having abnormal structure. However, the abnormal feet did not fit consistently with structures defined for RA, pes planus, or pes cavus foot types. Logistic regression demonstrated that subtalar joint synovitis was the only predictive factor for abnormal subtalar and midtarsal architecture (odds ratio 19.2, 95% confidence interval 1.77-200.0).Conclusion. This unique 3-D MRI-based technique successfully quantified the effects of RA on the geometric architecture of the foot and the patientspecific nature of these changes. This technique can be used to provide logical therapy for correction.

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Comparison of transfer sites for flexor digitorum longus in a cadaveric adult acquired flatfoot model

Vaudreuil

Ledoux

Roush

et al. 2013

Journal Orthopaedic Research

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Posterior tibialis tendon (PTT) dysfunction (PTTD) is associated with adult acquired flatfoot deformity. PTTD is commonly treated with a flexor digitorum longus (FDL) tendon transfer (FDLTT) to the navicular (NAV), medial cuneiform (CUN), or distal residuum of the degraded PTT (rPTT). We assessed the kinetic and kinematic outcomes of these three attachment sites using cadaveric gait simulation. Three transfer locations (NAV, CUN, rPTT) were tested on seven prepared flatfoot models using a robotic gait simulator (RGS). The FDLTT procedures were simulated by pulling on the PTT with biomechanically realistic FDL forces (rPTT) or by pulling on the transected FDL tendon after fixation to the navicular or medial cuneiform (NAV and CUN, respectively). Plantar pressure and foot bone motion were quantified. Peak plantar pressure significantly decreased from the flatfoot condition at the first metatarsal (NAV) and hallux (CUN). No difference was found in the medial-lateral center of pressure. Kinematic findings showed minimal differences between flatfoot and FDLTT specimens. The three locations demonstrated only minimal differences from the flatfoot condition, with the NAV and CUN procedures resulting in decreased medial pressures. Functionally, all three surgical procedures performed similarly.

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The Effect of Posterior Tibial Tendon Dysfunction on Hindfoot Kinematics

Cited by 102 publications

References 41 publications

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

The geometric architecture of the subtalar and midtarsal joints in rheumatoid arthritis based on magnetic resonance imaging

Comparison of transfer sites for flexor digitorum longus in a cadaveric adult acquired flatfoot model

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