Medial Arch Support Research Articles

Is there a role for surgical decompression in stage I tibialis posterior tendon dysfunction?

Background: Tibialis posterior tendon (TPT) dysfunction is a common disorder that affects both men and women. Stage I dysfunction is characterised by pain and swelling around the medial malleolus, along with mild weakness of the single heel raise test. Initial management consists of non-operative measures such as physiotherapy, anti-inflammatory drugs and medial arch supports. Surgery is rarely required as most cases settle with non-operative measures. Surgical decompression of the TPT should be performed if non-operative measures fail to relieve pain. Objective: The aim of this study was to assess the outcome of surgical decompression for stage I TPT dysfunction. Method: We prospectively studied 10 consecutive patients who underwent surgical decompression for stage I TPT dysfunction. Results: Our results demonstrate that surgical decompression reduces pain and permits an early return to normal activities. Conclusion: Surgical decompression should be performed for stage I TPT dysfunction if non-operative measures have failed to provide symptomatic relief.

Modified Kidner procedure utilizing a Mitek bone anchor

The recent development of small bone suture anchors has created several potential applications in reconstructive surgery of the foot. Mitek bone anchors are simple to insert, require less aggressive dissection and surgical time than reefing of the redundant posterior tibial tendon, and are a reliable method of tendon-to-bone fixation. Mitek bone anchors are an excellent technique for the treatment of redundant tibialis posterior tendon following a modified Kidner procedure. In modified Kidner procedures involving an excessively large os tibiale externum, Mitek anchoring of the redundant tibialis posterior tendon to the navicular bone is an excellent means for secure plication of the posterior tibial tendon in cases involving intraoperative tendon laxity. A description of the Mitek Anchor System and technique of application in a modified Kinder procedure is presented. The purpose of this study was to describe patient satisfaction and long-term clinical outcomes of the modified Kinder procedure with and without the Mitek bone anchoring system. A retrospective study of the modified Kinder procedure was performed with 13 patients being evaluated, seven with Mitek anchoring and six without. The University of Maryland 100-point Painful Foot Center Scoring System was modified to be more specific to the modified Kinder procedure for assessment of subjective long-term results. Patient overall satisfaction was rated good to excellent by 85.6% of patients in the Mitek group and by 100% of patients in the non-Mitek group. Use of the Mitek anchor allowed for quicker postoperative recovery to resumption of ambulation without assistive devices (average of 3 weeks vs. 4.42 weeks) and a quicker return to pain-free ambulation in normal shoegear (average of 4 weeks vs. 6 weeks). Mitek anchoring of the tibialis posterior tendon, theoretically, increases medial arch support as evidenced by 14% of the Mitek group and 67% of the non-Mitek group requiring postoperative orthotics.

後足部内反の評価におけるＣｏｂｅｙ法の有用性

Roentgenograms of 17 healthy adults' feet were taken in using Cobey's poterior view in a standing position. Medial and lateral wedge arch support were used. The medial side's degrees were 5, 10, 15, 20, and lateral side's degrees were 5, 10. In all roentgenograms we measured Ankle mortise-heel contact angle (A-H angle) and Tibiocalcaneal angle (TB-C angle). On the inversion side the mean A-H angle was 9.3, 7.7, 6.3, 5.6, 4.0 in 0, 5, 10, 15, 20, respechvely and mean TB-C angle was 1.7, 3.6, 6.4, 9.2, 11.5 in 0, 5, 10, 15, 20 respechvely. There was a significant relationship between degree of arch support and A-H angle or TB-C angle. On the eversion side, the mean A-H angle was 9.3, 8.6, 9.0 in 0, 5, 10, respechvely and that of TB-C angle was 1.7, 1.0, 1.2 in 0, 5, 10 respectively. There was no significant relationship between degree of arch support and A-H angle or TB-C angle. However the TB-C angle can distinguish the eversion side from that of the control or inversion side.

Footwear and foot orthotic effectiveness research: a new approach.

Measurement of calcaneal inversion and eversion during walking is limited when subjects wear shoes. The authors of this study propose the use of transverse tibial rotation as a viable alternative measurement when barefoot assessment is not possible. The purpose of this study, therefore, was to: 1) determine the relationship between transverse tibial rotation and rearfoot motion during the stance phase of normal walking and 2) demonstrate the usefulness of measuring transverse tibial rotation when evaluating the effect of footwear and insole foot orthotic devices. Part 1 consisted of eight volunteers (five women, three men) whose rearfoot and transverse tibial motion was videotaped while they walked along a 12-m walkway. The results of this study showed that although absolute values were not comparable, the two motion patterns are related to each other. The correlation between the mean rearfoot and tibial motion patterns of all 16 feet was r = .953. Part 2 investigated the effect of footwear and orthotics on transverse tibial rotation using two case presentations. A video camera was positioned in front of each subject as they walked at a self-selected speed under various footwear or orthotic conditions. The results of the case studies revealed that footwear or foot orthotics decrease maximum tibial internal rotation compared with barefoot walking. In addition, internal tibial rotation velocity and acceleration were decreased by the use of shoes, an accommodative orthosis, and an inflatable medial longitudinal arch support. A rigid orthotic produced a slight increase in transverse tibial rotation and a dramatic increase in transverse tibial acceleration.(ABSTRACT TRUNCATED AT 250 WORDS)

The Effect of Adhesive Strapping on Medial Longitudinal Arch Support before and after Exercise

The purpose of this study was to compare the ability of two methods of adhesive strapping to provide support to the medial longitudinal arch (MLA) before and after a standardized exercise of 10 minutes of jogging. Ten females, 19 to 35 years of age, were subjects. To determine the position of the MLA, the height of the navicular tuberosity from the floor was measured bilaterally while each subject was standing. Measurements were taken for the following three conditions: barefoot (BARE), before exercise with arches taped (PREEX), and after exercise with arches taped (POSTEX). Methods for taping the MLA were: 1) LowDye and 2) double X. Results of a two-way, within-subjects ANOVA were significant for conditions (F = 45.3, p < 0.0001) and tape methods x conditions interaction (F = 3.6, p < 0.05) but not for tape methods. The Tukey test resulted in a significant difference (p < 0.05) between BARE and PREEX and PREEX and POSTEX but not between BARE and POSTEX. Results indicate that support of the MLA by adhesive strapping was significantly diminished after exercise. J Orthop Sports Phys Ther 1991;14(1):18-23.

Gait analysis. Alterations in support phase forces using supportive devices.

This study documents changes in momentary distribution of forces under the foot, comparing barefoot gait to that with heel cups, medial arch supports, and low-dye taping. Cholesterol crystal force plate analysis and a computerized Kistler force platform were used in the study. Low-dye taping or a heel cup significantly diminished the duration of forces under the midfoot, medializing the instant center of forces. A medial arch support shifted the instant center of forces laterally, though it did not diminish the duration of forces under the arch. The relationship between these alterations of force distribution and the treatment of common runner's ailments such as plantar fasciitis, posterior tibial tendinitis, metatarsalgia, and shin splints is much clearer in the light of these results.

Medial Arch Support by Operation: Sustentaculum Tali Procedure

Medial Arch Support by Operation: Sustentaculum Tali Procedure