Pathological foot kinematics in subjects with stage II tibialis posterior dysfunction using a multisegmented foot model

Background: Stage II tibialis posterior tendon dysfunction (PTTD) resistant to conservative therapies is usually treated with invasive surgery. Posterior tibial tendoscopy is a novel technique being used in the assessment and treatment of posterior tibial pathology. The aims of this study were (1) to clarify the role of posterior tibial tendon tendoscopy in treating stage II PTTD, (2) to arthroscopically classify spring ligament lesions, and (3) to compare the arthroscopic assessment of spring ligament lesions with magnetic resonance imaging (MRI) and ultrasonographic (US) data. Methods: We reviewed prospectively collected data on 16 patients affected by stage II PTTD and treated by tendoscopy. We report the reoperation rate and functional outcomes evaluated by comparing pre- and postoperative visual analogic scale for pain (VAS-pain) and the Short-Form Health Survey (SF-36; with its physical [PCS] and mental [MCS] components). Postoperative satisfaction was assessed using a VAS-satisfaction scale. One patient was lost to follow-up. Spring ligament lesions were arthroscopically classified in 3 stages. Discrepancies between preoperative imaging and intraoperative findings were evaluated. Results: At a mean of 25.6 months’ follow-up, VAS-pain ( P < .001), SF-36 PCS ( P = .039), and SF-36 MCS ( P < .001) significantly improved. The mean VAS-satisfaction score was 75.3/100. Patients were relieved from symptoms in 80% of cases, while 3 patients required further surgery. MRI and US were in agreement with intraoperative data in 92% and 67%, respectively, for the tendon assessment and in 78% and 42%, respectively, for the spring ligament. Conclusions: Tendoscopy may be considered a valid therapeutic tool in the treatment of stage II PTTD resistant to conservative treatment. It provided objective and subjective encouraging results that could allow continued conservative therapy while avoiding more invasive surgery in most cases. MRI and US were proven more useful in detecting PT lesions than spring ligament tears. Further studies on PT could use this tendoscopic classification to standardize its description. Level of Evidence: Level IV, therapeutic study, case series.

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Randomized Controlled Trial Comparing Orthosis Augmented by Either Stretching or Stretching and Strengthening for Stage II Tibialis Posterior Tendon Dysfunction

Foot & Ankle International ◽

10.1177/1071100715579906 ◽

2015 ◽

Vol 36 (9) ◽

pp. 1006-1016 ◽

Cited By ~ 12

Author(s):

Jeff Houck ◽

Christopher Neville ◽

Josh Tome ◽

Adolph Flemister

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Stage Ii ◽

Tibialis Posterior ◽

Tibialis Posterior Tendon ◽

Randomized Controlled

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A comparison of foot kinematics between pregnant and non-pregnant women using the Oxford foot model during walking

International Journal of Biomedical Engineering and Technology ◽

10.1504/ijbet.2020.10032547 ◽

2020 ◽

Vol 34 (1) ◽

pp. 20

Author(s):

Minjun Liang ◽

Wenlan Lian ◽

Yang Song

Keyword(s):

Pregnant Women ◽

Foot Kinematics ◽

Foot Model ◽

Oxford Foot Model

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Analysis of Foot Kinematics with Unstable Sole Structure Using Oxford Foot Model

Journal of Biomimetics Biomaterials and Biomedical Engineering ◽

10.4028/www.scientific.net/jbbbe.34.1 ◽

2017 ◽

Vol 34 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Ying Yue Zhang ◽

Gusztáv Fekete ◽

Justin Fernandez ◽

Yao Dong Gu

Keyword(s):

Sagittal Plane ◽

Plantar Flexion ◽

Three Dimensional ◽

Frontal Plane ◽

The Body ◽

Control Effect ◽

Foot Kinematics ◽

Foot Model ◽

Contrast Group ◽

Oxford Foot Model

To determine the influence of the unstable sole structure on foot kinematics and provide theoretical basis for further application.12 healthy female subjects walked through a 10-meter experimental channel with normal speed wearing experimental shoes and control shoes respectively at the gait laboratory. Differences between the groups in triplanar motion of the forefoot, rearfoot and hallux during walking were evaluated using a three-dimensional motion analysis system incorporating with Oxford Foot Model (OFM). Compare to contrast group, participants wearing experimental shoes demonstrated greater peak forefoot dorsiflexion, forefoot supination and longer halluces plantar flexion time in support phase. Additionally, participants with unstable sole structure also demonstrated smaller peak forefoot plantarflexion, rearfoot dorsiflexion and range of joint motion in sagittal plane and frontal plane.. The difference mainly appeared in sagittal and frontal plane. With a stimulation of unstable, it may lead to the reinforcement of different flexion between middle and two ends of the foot model. The greater forefoot supination is infered that the unstable element structure may affect the forefoot motion on the frontal plane and has a control effect to strephexopodia people. The stimulation also will reflexes reduce the range of rearfoot motion in sagittal and frontal planes to control the gravity center of the body and keep a steady state in the process of walking.

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Custom-Molded Foot-Orthosis Intervention and Multisegment Medial Foot Kinematics During Walking

Journal of Athletic Training ◽

10.4085/1062-6050-46.4.358 ◽

2011 ◽

Vol 46 (4) ◽

pp. 358-365 ◽

Cited By ~ 5

Author(s):

Stephen C. Cobb ◽

Laurie L. Tis ◽

Jeffrey T. Johnson ◽

Yong “Tai” Wang ◽

Mark D. Geil

Keyword(s):

Repeated Measures ◽

Three Dimensional ◽

Metatarsophalangeal Joint ◽

Foot Kinematics ◽

First Metatarsophalangeal Joint ◽

Lower Extremity Injuries ◽

Full Contact ◽

Foot Posture ◽

Foot Model ◽

Foot Orthosis

Context: Foot-orthosis (FO) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinically. However, the results of quantitative gait analyses have been equivocal. The foot models used, participants receiving intervention, and orthoses used might contribute to the variability. Objective: To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture. Design: Crossover study. Setting: University biomechanics and ergonomics laboratory. Patients or Other Participants: Sixteen participants with low-mobile foot posture (7 men, 9 women) were assigned randomly to 1 of 2 FO groups. Intervention(s): After a 2-week period to break in the FOs, individuals participated in a gait analysis that consisted of 5 successful walking trials (1.3 to 1.4 m/s) during no-FO and FO conditions. Main Outcome Measure(s): Three-dimensional displacements during 4 subphases of stance (loading response, mid-stance, terminal stance, preswing) were computed for each multisegment foot model articulation. Results: Repeated-measures analyses of variance (ANOVAs) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition (F1,14 = 5.24, P = .04, partial η2 = 0.27). Terminal stance repeated-measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex (F1,14 = 7.87, P = .01, partial η2 = 0.36). However, additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis (F1,14 = 4.32, P = .08, partial η2 = 0.38) or full-contact orthosis (F1,14 = 4.10, P = .08, partial η2 = 0.37). Conclusions: Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures. Furthermore, FO intervention might partially correct dys-functional kinematic patterns associated with low-mobile foot postures.

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Effects of a 4-Week Short-Foot Exercise Program on Gait Characteristics in Patients With Stage II Posterior Tibial Tendon Dysfunction

Journal of Sport Rehabilitation ◽

10.1123/jsr.2019-0211 ◽

2021 ◽

Vol 30 (1) ◽

pp. 120-128

Author(s):

Jinah Kim ◽

Sung Cheol Lee ◽

Youngmin Chun ◽

Hyung-Pil Jun ◽

Jeffrey G. Seegmiller ◽

...

Keyword(s):

Ankle Joint ◽

Tibialis Anterior ◽

Muscle Activation ◽

Stage Ii ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Foot Deformity ◽

Posterior Tibial Tendon Dysfunction ◽

Maximum Voluntary Isometric Contraction ◽

Posterior Tibial

Context: Clinically, it has been suggested that increased activation of intrinsic foot muscles may alter the demand of extrinsic muscle activity surrounding the ankle joint in patients with stage II posterior tibial tendon dysfunction. However, there is limited empirical evidence supporting this notion. Objective: The purpose of this study was to investigate the effects of a 4-week short-foot exercise (SFE) on biomechanical factors in patients with stage II posterior tibial tendon dysfunction. Design: Single-group pretest–posttest. Setting: University laboratory. Participants: Fifteen subjects (8 males and 7 females) with stage II posterior tibial tendon dysfunction who had pain in posterior tibial tendon, pronated foot deformity (foot posture index ≥+6), and flexible foot deformity (navicular drop ≥10 mm) were voluntarily recruited. Intervention: All subjects completed a 4-week SFE program (15 repetitions × 5 sets/d and 3 d/wk) of 4 stages (standing with feedback, sitting, double-leg, and one-leg standing position). Main Outcome Measures: Ankle joint kinematics and kinetics and tibialis anterior and fibularis longus muscle activation (% maximum voluntary isometric contraction) during gait were measured before and after SFE program. Cohen d effect size (ES [95% confidence intervals]) was calculated. Results: During the first rocker, tibialis anterior activation decreased at peak plantarflexion (ES = 0.75 [0.01 to 1.49]) and inversion (ES = 0.77 [0.03 to 1.51]) angle. During the second rocker, peak dorsiflexion angle (ES = 0.77 [0.03 to 1.51]) and tibialis anterior activation at peak eversion (ES = 1.57 [0.76 to 2.39]) reduced. During the third rocker, the peak abduction angle (ES = 0.80 [0.06 to 1.54]) and tibialis anterior and fibularis longus activation at peak plantarflexion (ES = 1.34 [0.54 to 2.13]; ES = 1.99 [1.11 to 2.86]) and abduction (ES = 1.29 [0.50 to 2.08]; ES = 1.67 [0.84 to 2.50]) decreased. Conclusions: Our 4-week SFE program may have positive effects on changing muscle activation patterns for tibialis anterior and fibularis longus muscles, although it could not influence their structural deformity and ankle joint moment. It could produce a potential benefit of decreased tibialis posterior activation.

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Lateral Column Lengthening Versus Medial Displacement Calcaneal Osteotomy in Stage II Tibialis Posterior Tendon Dysfunction: Randomized Controlled Trial

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00360 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0036

Author(s):

Amr A. Mohammed ◽

Hossam Abubeih ◽

Ahmed Osman ◽

Wael Eladly ◽

Ahmed Khalifa ◽

...

Keyword(s):

Disease Process ◽

Stage Ii ◽

Tibialis Posterior ◽

Posterior Tibial Tendon ◽

Posterior Tibial ◽

Calcaneal Osteotomy ◽

Additional Surgery ◽

Flat Feet ◽

Significant Difference ◽

Adult Acquired Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: Adult acquired flatfoot deformity is a complex deformity associated with the collapse of the medial longitudinal arch. Several factors have been proposed in the etiology of adult acquired flatfoot deformity including arthritic, neuromuscular, and traumatic conditions; however, posterior tibial tendon dysfunction remains the most common etiology. A spectrum of conditions affecting the posterior tibial tendon has been identified, with tendinitis occurring early in the disease process and tendon rupture occurring at the more advanced stages. Adult-acquired flatfoot deformity requires a complex operative plan that often utilizes several procedures to correct deformity, at both the hindfoot and midfoot. The objective of this study was to compare the efficacy of two different osteotomies commonly used to correct flexible flat feet. Methods: 42 Patients (21 males and 21 females) with stage II PTTD acquired flexible flatfeet were included with a mean age of 49.62 +- 6.2. Twinty-two patients had medial displacement calcaneal osteotomy (MDCO) while 20 cases had latercal column lenghtening (LCL). Strayer procedure, spring ligament plication and FDL transfer were done in all patients. Pre- and Post-operative clinical assessment was done using AOFAS and FFI questionaire. Six radiographic parameters were analyzed, two in the anteroposterior view ( talo-navicular coverage and talo-calcaneal angle), three in lateral view ( talo- first metatarsus angle, talo- calcaneal angle and calcaneal inclination angle) and tibio-calcanal angle in axial view. Results: At a mean follow up of 12 months, significant improvement in AOFAS and FFI scores in MDCO and LCL groups with no significant difference between both groups. Postoperative significant improvements in all radiographic measurements in both groups. LCL group showed significant better correction in TNC and calcaneal inclination angles when compared to MDCO group. However, MDCO procedure showed significantly better correction in axial tibial calcaneal angle. Both techniques correct the deformity, however cases received LCL has better correction than MDCO cases and less reoperation rate. Conclusion: Reconstructions performed with LCL produced a greater change in the realignment of adult acquired flatfoot, maintained more of their initial correction over time, and were associated with a lower incidence of additional surgery than reconstructions with a MDCO of the calcaneus. However, a higher incidence of degenerative change in the hindfoot was observed in the LCL group. The ability of LCL to correct the deformity in anteroposterior and lateral plan and MDCO in lateral and axial plan suggests that proper osteotomy should be planned according to the existing deformity. Combination of both techniques may be required in certain cases.

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