The Relationship Between Ankle, Hindfoot, and Forefoot Position and Posterior Tibial Muscle Excursion

Abstract

The purpose of this study was to examine the relationship of forefoot position in the transverse plane (abduction/adduction), hindfoot position in the frontal plane (eversion/inversion), and ankle position in the sagittal plane (plantarflexion/dorsiflexion) with posterior tibialis (PT) muscle excursion using an in vitro cadaver model. Seven fresh-frozen cadaver specimens were potted and mounted on a frame. The PT tendon was dissected 15 cm proximal to the medial malleolus, and a 5-kg weight was sutured to the tendon. A six-camera motion analysis system (Optotrak, Northern Digital, Inc.) was used to track three-dimensional (3-D) motion of the tibia, calcaneus (hindfoot) and first metatarsal (forefoot) using bone pins. The ankle, hindfoot, and forefoot were manually placed in 24 different ankle and foot positions. A stepwise regression analysis was used to examine the relationship among ankle, hindfoot, and forefoot kinematics and PT muscle excursion. Hindfoot eversion/inversion and forefoot abduction/adduction accounted for 77% of the variance in PT muscle excursion, with small contributions from ankle plantarflexion/dorsiflexion (5.7%) and forefoot plantarflexion/dorsiflexion (1.9%). A combined regression equation applied to individual specimens resulted in average errors of less than 2.5 mm. This study supports the hypothesis that PT muscle excursion can be estimated using specific foot and ankle kinematic variables. Further, these data suggest that hindfoot eversion and forefoot abduction account for most of the variance in PT muscle excursion and are theorized to be important to control clinically altering the length of the posterior tibial muscle.