Abstract
Tibialis posterior has a vital role during gait as the primary dynamic stabiliser of the medial longitudinal arch; however, the muscle and tendon are prone to dysfunction with several conditions. We present an overview of tibialis posterior muscle and tendon anatomy with images from cadaveric work on fresh frozen limbs and a review of current evidence that define normal and abnormal tibialis posterior muscle activation during gait. A video is available that demonstrates ultrasound guided intra-muscular insertion techniques for tibialis posterior electromyography.Current electromyography literature indicates tibialis posterior intensity and timing during walking is variable in healthy adults and has a disease-specific activation profile among different pathologies. Flat-arched foot posture and tibialis posterior tendon dysfunction are associated with greater tibialis posterior muscle activity during stance phase, compared to normal or healthy participants, respectively. Cerebral palsy is associated with four potentially abnormal profiles during the entire gait cycle; however it is unclear how these profiles are defined as these studies lack control groups that characterise electromyographic activity from developmentally normal children. Intervention studies show antipronation taping to significantly decrease tibialis posterior muscle activation during walking compared to barefoot, although this research is based on only four participants. However, other interventions such as foot orthoses and footwear do not appear to systematically effect muscle activation during walking or running, respectively. This review highlights deficits in current evidence and provides suggestions for the future research agenda.
Highlights
The tibialis posterior (TP) muscle has a vital role during gait; via multiple insertion points into the tarsal bones it acts as the primary dynamic stabiliser of the rearfoot and medial longitudinal arch (MLA) [1,2]
The purpose of this paper is to provide an overview of TP muscle and tendon anatomy and to review current evidence that describes normal and abnormal tibialis posterior muscle activation during gait based on EMG
Whilst this study has provided important preliminary evidence in terms of TP function; the findings are limited by the small sample size and the results were expressed relative to a maximum voluntary contraction which may have been influenced by patient symptoms [37]
Summary
The tibialis posterior (TP) muscle has a vital role during gait; via multiple insertion points into the tarsal bones it acts as the primary dynamic stabiliser of the rearfoot and medial longitudinal arch (MLA) [1,2]. Intramuscular electrodes have been utilised to assess TP muscle activation among infants, children and young adult patients (age range: 4–24 years) – often as part of a surgical planning procedure (Figure 4d–g) [46,47,48,49,50] Among these studies, TP muscle dysfunction is reported to include; (i) an active 'out of phase burst' (i.e. greater activity during swing phase compared to stance phase), and (ii) a continuous burst throughout the gait cycle [48]. A further study by Michlitsch and colleagues [49] involved a retrospective study from pre-operative data recorded from seventy-eight patients assessed over an 11-year period They reported approximately 1/3 of varus deformities linked with cerebral palsy are associated with TP alone and a further 1/3 are associated with abnormal activity from a combination of abnormal TP and tibialis anterior muscle dysfunction. While there is some preliminary evidence regarding the effect of antipronation tape on TP EMG muscle function [55], the available literature comprises only one investigation based on four participants
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