Posterior Tibial Tendon Insufficiency: Which Ligaments are Involved?

Deland, Jonathan T.; de, Richard J.; Sung, Il Hoon; Ernberg, Lauren A.; Potter, Hollis G.

doi:10.1177/107110070502600601

Cited by 243 publications

(195 citation statements)

References 24 publications

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“…20 The superomedial and inferomedial calcaneonavicular, talocalcaneal interosseous, plantar naviculocuneiform, plantar first metatarsocuneiform, and anterior superficial deltoid ligaments were attenuated with multiple longitudinal incisions parallel to the fiber orientation. Attenuation was continued by cyclic axial loading using an ElectroForce 3400 axial testing frame (Bose, Minnetonka, MN).…”

Section: Methodsmentioning

confidence: 99%

“…6,14,15,[17][18][19] Sectioning simulates complete rupture, which does not typically occur in vivo. 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.…”

mentioning

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%

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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%

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confidence: 99%

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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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“…Commonly, there is more than 30 % talonavicular uncoverage (Fig. 2), determined by a more substantial failure of the spring ligament and secondary restraints of the arch [2]. This results in greater forefoot abduction.…”

Section: Stagingmentioning

confidence: 99%

“…However, AAFD results from a combination of PTT insufficiency and failure of both capsular and ligamentous structures of the foot. The spring ligament (ie, calcaneonavicular) is the most frequently affected [2], often leading to a combined plantar sag or forefoot abduction through the talonavicular and subtalar joints. Consequently, a combination of plantar and medial migration of the talar head leads to flattening of the arch as the foot displaces from underneath the talus [3].…”

Section: Introductionmentioning

confidence: 99%

Approach and treatment of the adult acquired flatfoot deformity

Vulcano

Deland

Ellis

2013

Curr Rev Musculoskelet Med

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102

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Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.

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Anatomic Risk Factors for Diabetic Foot Ulceration

Tsapogas

2019

Atlas of the Diabetic Foot

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Posterior Tibial Tendon Insufficiency: Which Ligaments are Involved?

Abstract: Ligament involvement is extensive in PTTI, and the spring ligament complex is the most frequently affected. Because ligament pathology in PTTI is nearly as common as posterior tibial tendinopathy, treatment should seek to protect or prevent progressive failure of these ligaments.

Cited by 243 publications

References 24 publications

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Cadaveric flatfoot model: Ligament attenuation and Achilles tendon overpull

Approach and treatment of the adult acquired flatfoot deformity

Anatomic Risk Factors for Diabetic Foot Ulceration

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