Exploring the clinical presentation of tibialis posterior tendinopathy

Abstract

Foot pain is a common musculoskeletal complaint, that is associated with significant functional limitations and is often accompanied by systemic co-morbidities. Pain on the medial aspect of the foot and ankle between the medial malleolus and navicular is often diagnosed as dysfunction of the tibialis posterior tendon. Tibialis posterior tendinopathy (TPT) is considered to constitute the early stages of a condition that progresses to an acquired flatfoot deformity. Surgical intervention is recommended when conservative approaches are unsuccessful, with invasive and costly procedures recommended when significant deformity and dysfunction are present. Effective management in the early stages when tendon signs and symptoms predominate is desirable in order to prevent or delay progression of the condition. The overarching objective of this thesis was to inform the future development of targeted interventions for TPT. Specific thesis aims were to systematically synthesise current evidence in relation to terminology, clinical presentation and management of TPT (Part A) and to address current gaps in the literature in relation to diagnosis, and to explore the presentation of TPT using the ICF framework (Part B). iv Publications included in this thesis Ross MH, Smith MD, Vicenzino B. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: Are they one and the same? A systematic review. PLoS One. 2017;12(12):e0187201. Ross MH, Smith MD, Vicenzino B. Self-reported social and activity restrictions accompany local postural and strength impairments in posterior tibial tendon dysfunction: a systematic review. v Submitted manuscripts included in this thesis Ross MH, Smith MD, Durbridge, G, Vicenzino B. The diagnostic accuracy of clinical tests to diagnose ultrasound-confirmed tibialis posterior tendinopathy in patients presenting with medial foot/ankle pain. Submitted to BJSM. vi Other publications during candidature (as at May 2019) Peer-Reviewed PapersRoss MH, Setchell J. People who identify as LGBTIQ+ can experience assumptions, discomfort, some discrimination, and a lack of knowledge while attending physiotherapy: a survey.Plinsinga ML, Ross MH, Coombes BK, et al. Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis.