Pathoanatomy and Etiology of Posterior Tibial Tendon Dysfunction

Sm, Mosier; Pomeroy, Gregory; Manoli, Arthur

doi:10.1097/00003086-199908000-00003

Cited by 107 publications

(61 citation statements)

References 34 publications

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“…5,7,34 Thus, PTTD progression may be best understood by rearfoot kinematic measures during stage I, whereas altered midfoot and forefoot kinematics may play a role in stage II and beyond. 19,20 Finally, the results of the current study also suggest that patients with stage I PTTD exhibit similar arch structure and ankle invertor strength as compared to healthy controls and that these variables may not be associated with early identification of the condition. 5,34 In contrast, individuals in the more severe stages of the PTTD progression generally exhibit marked differences in arch height, strength, and gait kinematics.…”

Section: Discussionmentioning

confidence: 49%

“…5,34 In contrast, individuals in the more severe stages of the PTTD progression generally exhibit marked differences in arch height, strength, and gait kinematics. 20,24 Several limitations are acknowledged. First, this study did not include the classically defined PTTD demographic of sedentary women over the age of 40, who are diabetic or obese.…”

Section: Discussionmentioning

confidence: 99%

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

Rabbito

Pohl²,

Humble³

et al. 2011

J Orthop Sports Phys Ther

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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.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

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

Rabbito

Pohl²,

Humble³

et al. 2011

J Orthop Sports Phys Ther

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show abstract

“…Unfortunately, the diagnosis may be delayed and deformity progressively increases. In addition, with time, irreversible atrophy and degeneration affect the tibialis posterior muscle and tendon [15]. We therefore assessed patient function and satisfaction after a modified Cobb reconstruction in a group of patients with TPD demonstrating early, flexible deformity using a modification of the Johnson and Strom classification and to confirm or refute the ability of the technique to prevent subsequent fixed deformity.…”

Section: Discussionmentioning

confidence: 99%

Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

Parsons

Naim

Richards

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Cobb described a method of reconstruction in Johnson and Strom Type II tibialis posterior dysfunction (TPD) using a split tibialis anterior musculotendinous graft. We assessed patient function and satisfaction after a modified Cobb reconstruction in a group of patients with a narrow spectrum of dysfunction, examined a modification of the Johnson and Strom classification to emphasize severity of deformity, and assessed the ability of the technique to prevent subsequent fixed deformity. We prospectively followed 32 patients managed by this technique and a translational os calcis osteotomy with early flexible deformity after failed conservative treatment. There were 28 women and four men with unilateral disease. The average followup was 5.1 years. Staging was confirmed clinically and with imaging. The modified surgery involved a bone tunnel in the navicular rather than the medial cuneiform with plaster for 8 weeks followed by orthotics and physiotherapy.

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“…Mechanical factors must also be at play. 20 Abnormal forces arising from even mild flat-footedness may result in lifelong greater demands on the PTT. [21][22][23][24] Another possible mechanical cause is overpull of the opposing peroneus brevis muscle.…”

Section: Epidemiologymentioning

confidence: 99%

Adult acquired flat foot deformity: The joint-preserving procedures in stage II tibialis posterior tendon dysfunction

Saragas

Ferrao

2016

SA orthop. j.

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Pathoanatomy and Etiology of Posterior Tibial Tendon Dysfunction

Cited by 107 publications

References 34 publications

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

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

Correction and Prevention of Deformity in Type II Tibialis Posterior Dysfunction

Adult acquired flat foot deformity: The joint-preserving procedures in stage II tibialis posterior tendon dysfunction

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