The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England

Kohls-Gatzoulis, Julie; Woods, Barrett I.; Angel, John; Singh, Dishan

doi:10.1016/j.fas.2008.08.003

Cited by 107 publications

(108 citation statements)

References 9 publications

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“…This reflects the higher incidence of PTTD in females within this age range. 24 Thus the conclusions of the present study can only be applied to middle-aged women with early PTTD. Secondly, we chose to measure hip extensor and abductor performance via dynamometry, which is a performance measure not consistently used in the clinical setting.…”

Section: Discussionmentioning

confidence: 94%

Women With Posterior Tibial Tendon Dysfunction Have Diminished Ankle and Hip Muscle Performance

Kulig¹,

Popovich²,

Noceti-Dewit³

et al. 2011

J Orthop Sports Phys Ther

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Persons with acquired flatfoot deformity demonstrate impaired walking performance, as indicated by slower walking speed and frequent reports of foot pain during activity and at rest. 25,29 There is no doubt that acquired flatfoot deformity is accompanied by some level of tibialis posterior tendon dysfunction. The tibialis posterior functions to create a rigid foot segment by stabilizing the midfoot 37 and assists in generating energy, by the plantar flexors in terminal stance, to produce successful propulsion. 41 Laboratory studies confirm that persons with acquired flatfoot deformity demonstrate T T STUDY DESIGN: Controlled laboratory study using a cross-sectional design. T T OBJECTIVES:To characterize ankle and hip muscle performance in women with posterior tibial tendon dysfunction (PTTD) and compare them to matched controls. We hypothesized that ankle plantar flexor strength, and hip extensor and abductor strength and endurance, would be diminished in women with PTTD and this impairment would be on the side of dysfunction. T T BACKGROUND:Individuals with PTTD demonstrate impaired walking abilities. Walking gait is strongly dependent on the performance of calf and hip musculature. T T METHODS:Thirty-four middle-aged women (17 with PTTD) participated. Ankle plantar flexor strength was assessed with the single-leg heel raise test. Hip muscle performance, including strength and endurance, were dynamometrically measured. Differences between groups and sides were assessed with a mixed-model analysis of variance. T T RESULTS:Females with PTTD performed significantly fewer single-leg heel raises and repeated sagittal and frontal plane non-weight-bearing leg lifts, and also had lower hip extensor and abductor torques than age-matched controls. There were no differences between sides for hip strength and endurance measures for either group, but differences between sides in ankle strength measures were noted in both groups. T T CONCLUSION:Women with PTTD demonstrated decreased ankle and hip muscle performance bilaterally.

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Section: Discussionmentioning

confidence: 94%

Women With Posterior Tibial Tendon Dysfunction Have Diminished Ankle and Hip Muscle Performance

Kulig¹,

Popovich²,

Noceti-Dewit³

et al. 2011

J Orthop Sports Phys Ther

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“…First, this study did not include the classically defined PTTD demographic of sedentary women over the age of 40, who are diabetic or obese. 13,14 However, the use of a younger, more active population is supported by previous research demonstrating PTTD that is a common injury among runners. 31,36 It is also possible that stage I PTTD is distinct and only associated with tendon overload due to the altered rearfoot mechanics reported in the current study.…”

Section: Discussionmentioning

confidence: 95%

“…Once selected, potential subjects were screened according to specific inclusion and exclusion criteria. 11,13,14 Each subject was required to meet the following inclusion criteria to qualify for the PTTD group: (1) mild swelling and/or tenderness posterior to the medial malleolus, (2) pain posterior and/or superior to the medial malleolus, aggravated by recreational activity, (3) pain that had been present for at least 3 weeks, and (4) participation in recreational running or walking a minimum of 3 times per week and 30 minutes per session. Subjects were excluded from the PTTD group if they met any of the following exclusion criteria: (1) previous surgery on the affected foot, leg, or knee; (2) osteoarthritis in the knee of the affected side; (3) fixed rearfoot deformities; (4) recurrent ankle sprains on the affected side; (5) ligament tears or boney abnormalities of the affected foot; (6) a physical or medical condition that contraindicated the testing protocol; (7) pregnancy; or (8) flexor hallucis longus or flexor digitorum longus tendinopathy.…”

mentioning

confidence: 99%

“…29 No individuals with stage II PTTD were screened, most likely because the sample was recruited primarily from sports medicine clinics, which typically see patients involved in recreational sports that demand a level of activity limited by stage II PTTD. 11,13,14 Control subjects (9 females and 3 males) were matched to individuals with PTTD (9 females and 3 males), based on age, gender, and body mass index (BMI), and screened by the same exclusion criteria as those used to screen the PTTD group. There were no statistical differences between groups for the variables listed in TABLE 1 and other demographic variables.…”

mentioning

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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“…This chronic debilitating condition typically occurs in obese middle-aged females, 6,[10][11][12][13] with up to 10% prevalence in this group 14 and is known to increase with age, 15,16 peaking at 55 years of age. 8 Other risk factors such as diabetes mellitus, 15 hypertension, 15 steroid injection around the tendon, 17,18 and seronegative spondyloarthropathies 6,19 have been implicated.…”

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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The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England

Cited by 107 publications

References 9 publications

Women With Posterior Tibial Tendon Dysfunction Have Diminished Ankle and Hip Muscle Performance

Women With Posterior Tibial Tendon Dysfunction Have Diminished Ankle and Hip Muscle Performance

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

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

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