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

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.

3D foot kinematic difference in Posterior Tibial Tendon Dysfunction stage II/III and control group

2016 ◽  
Vol 22 (2) ◽  
pp. 11
Author(s):  
S. Wuite ◽  
K. Deschamps ◽  
C. Roels ◽  
M. van de Velde ◽  
F. Staes ◽  
...  
Keyword(s):  
Stage Ii ◽  
Control Group ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Posterior Tibial ◽  
And Control

scholarly journals Efek Injeksi Plasma Kaya Platelet Terhadap Tenosinovitis Tendon Tibialis Posterior: Sebuah Studi Kasus

2019 ◽  
Vol 5 (1) ◽  
pp. 60-65
Author(s):  
Henry Ricardo Handoyo ◽  
Andryan Hanafi Bakri ◽  
Andri Primadhi Primadhi
Keyword(s):  
Platelet Rich Plasma ◽  
Tibialis Posterior ◽  
Medial Malleolus ◽  
Posterior Tibial Tendon ◽  
Foot And Ankle ◽  
Posterior Tibial Tendon Dysfunction ◽  
Flat Foot ◽  
Posterior Tibial ◽  
Left Ankle ◽  
History Of

Introduction: Posterior tibial tendon dysfunction is one of the most common, problems of the foot and ankle. Tenosynovitis of the posterior tibial tendon (PTT) is an often unrecognized form of PTT dysfunction. Case: A 54-year-old woman presented with left ankle pain that began while morning walk three days prior. She noted that the left ankle hurt with even light touch and the pain was unrelieved with sodium diclofenac. She denied any history of trauma. She was seen in the outpatient clinic for this condition. On examination, a three centimeter area of pain was found posterior to the medial malleolus and parallel to the PTT. She also had a stage I flat foot and mild soft tissue swelling around medial malleolus region on her radiograph examination. Ultrasound examination was done with the result of anechoic fluid visible in the peritendinous space around the PTT. The patient received diagnosis of PTT tenosynovitis, with the foot and ankle disability index (FADI) score was 58.7. Platelet rich plasma (PRP) injection was done twice with an interlude of two weeks. The pain subsided and the following FADI score was 84.6. Outcome: Patient showed improvement in her left ankle PTT tenosynovitis after two PRP injection. Conclusion: This case report highlights the efficacy of PRP as a modality in managing PTT tenosynovitis.

Role of Tendoscopy in Treating Stage II Posterior Tibial Tendon Dysfunction

2018 ◽  
Vol 39 (4) ◽  
pp. 433-442 ◽  
Author(s):  
Alessio Bernasconi ◽  
Francesco Sadile ◽  
Matthew Welck ◽  
Nazim Mehdi ◽  
Julien Laborde ◽  
...  
Keyword(s):  
Invasive Surgery ◽  
Stage Ii ◽  
Preoperative Imaging ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Sf 36

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.

Surgical Treatment of Stage I Posterior Tibial Tendon Dysfunction

1994 ◽  
Vol 15 (12) ◽  
pp. 646-648 ◽  
Author(s):  
Robert D. Teasdall ◽  
Kenneth A. Johnson
Keyword(s):  
Severe Pain ◽  
Stage I ◽  
Complete Relief ◽  
Posterior Tibial Tendon ◽  
Moderate Pain ◽  
Foot Deformity ◽  
Medial Aspect ◽  
Posterior Tibial Tendon Dysfunction ◽  
Posterior Tibial ◽  
Surgical Release

Nineteen patients underwent surgical synovectomy and debridement for the clinical diagnosis of stage I posterior tibial tendon (PTT) dysfunction. Stage I PTT dysfunction is characterized by pain and swelling along the medial aspect of the ankle. Fourteen patients (74%) reported complete relief of pain, 3 patients (16%) reported minor pain, and 1 patient (5%) had moderate pain, and 1 (5%) had continued severe pain. Sixteen (84%) of the patients subjectively reported being “much better” and had a return of function of the PTT, as evidenced by their ability to perform a single limb-heel-rise test. Two patients (10%) underwent subtalar arthrodesis for progressive foot deformity and continued pain. Based on these results, surgical release, tenosynovectomy, and debridement are recommended for the treatment of stage I PTT dysfunction.

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

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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