Posterior Tibial Tendon Dysfunction Stage Research Articles

Orthotic treatment for stage I and II posterior tibial tendon dysfunction (flat foot): A systematic review

Objective: To investigate whether orthotic treatment is effective for the treatment of posterior tibial tendon dysfunction stages I and II (flat foot). Data Sources: Five databases (PubMed, Scopus, PEDro, SPORTDiscus and The Cochrane Library) were searched for potential RCTs from their inception until August 2020. Review Methods: Only randomised controlled trials (RCT) that included subjects diagnosed with posterior tibial dysfunction in the initial stage and treated with orthotic treatments were selected. The outcomes assessed were whatever symptom related to posterior tibial tendon dysfunction stage I and II. Included RCTs were appraised using the Cochrane collaboration risk of bias tool. Results: Four RCT articles and 186 subjects were included. 75% were at high risk of bias for blinding of participants and personnel. Three different types of conservative treatment were used in the studies: foot/ankle-foot orthoses, footwear and stretching /strengthening exercises. Foot orthoses, together with exercise programmes, seemed to improve the effect of orthotic treatment. Foot orthoses with personalised internal longitudinal arch support were more effective than flat insoles or standard treatments in reducing pain. Conclusions: The use of orthotic treatment may be effective in reducing pain in the early stages of posterior tibial tendon dysfunction. Further research is needed into individualised orthotic treatment and high-intensity monitored exercise programmes.

Results of subtalar arthroereisis for posterior tibial tendon dysfunction stage IIA1. Based on 35 patients

BackgroundThe aim of the study was to evaluate the clinical and radiological results obtained in the treatment of adult flexible flatfoot secondary to posterior tibial dysfunction with subtalar arthroereisis using a Kalix ® endorthesis. Methods35 patients (37 feet) were studied, having been operated between January 2010 and January 2015 for reducible flatfoot secondary to posterior tibial tendon dysfunction stage IIA1 of Bluman. ResultsThe average follow up was 47.52 months with a minimum of 14 months and a maximum of 75 months. The average age was 54.85, with an age range from 40 to 80 years old. In 74% of cases excellent or good results were obtained, according to our evaluation. The most common complication of this procedure was persistent pain in the sinus tarsi. 35% of cases in this group required implant removal for this reason. ConclusionsWe believe that arthroereisis is valid for the treatment of flat foot secondary to posterior tibial tendon dysfunction at this stage, giving a high percentage of good and excellent results.

3D foot kinematic difference in Posterior Tibial Tendon Dysfunction stage II/III and control group

3D foot kinematic difference in Posterior Tibial Tendon Dysfunction stage II/III and control group

Non-surgical treatment of pain associated with posterior tibial tendon dysfunction: study protocol for a randomised clinical trial.

BackgroundSymptoms associated with pes planovalgus or flatfeet occur frequently, even though some people with a flatfoot deformity remain asymptomatic. Pes planovalgus is proposed to be associated with foot/ankle pain and poor function. Concurrently, the multifactorial weakness of the tibialis posterior muscle and its tendon can lead to a flattening of the longitudinal arch of the foot. Those affected can experience functional impairment and pain. Less severe cases at an early stage are eligible for non-surgical treatment and foot orthoses are considered to be the first line approach. Furthermore, strengthening of arch and ankle stabilising muscles are thought to contribute to active compensation of the deformity leading to stress relief of soft tissue structures. There is only limited evidence concerning the numerous therapy approaches, and so far, no data are available showing functional benefits that accompany these interventions.MethodsAfter clinical diagnosis and clarification of inclusion criteria (e.g., age 40–70, current complaint of foot and ankle pain more than three months, posterior tibial tendon dysfunction stage I & II, longitudinal arch flattening verified by radiography), sixty participants with posterior tibial tendon dysfunction associated complaints will be included in the study and will be randomly assigned to one of three different intervention groups: (i) foot orthoses only (FOO), (ii) foot orthoses and eccentric exercise (FOE), or (iii) sham foot orthoses only (FOS). Participants in the FOO and FOE groups will be allocated individualised foot orthoses, the latter combined with eccentric exercise for ankle stabilisation and strengthening of the tibialis posterior muscle. Participants in the FOS group will be allocated sham foot orthoses only. During the intervention period of 12 weeks, all participants will be encouraged to follow an educational program for dosed foot load management (e.g., to stop activity if they experience increasing pain). Functional impairment will be evaluated pre- and post-intervention by the Foot Function Index. Further outcome measures include the Pain Disability Index, Visual Analogue Scale for pain, SF-12, kinematic data from 3D-movement analysis and neuromuscular activity during level and downstairs walking. Measuring outcomes pre- and post-intervention will allow the calculation of intervention effects by 3×3 Analysis of Variance (ANOVA) with repeated measures.DiscussionThe purpose of this randomised trial is to evaluate the therapeutic benefit of three different non-surgical treatment regimens in participants with posterior tibial tendon dysfunction and accompanying pes planovalgus. Furthermore, the analysis of changes in gait mechanics and neuromuscular control will contribute to an enhanced understanding of functional changes and eventually optimise conservative management strategies for these patients.Trial registrationClinicalTrials.gov Protocol Registration System: ClinicalTrials.gov ID NCT01839669

The Modified Kidner-Cobb Procedure for Symptomatic Flexible Pes Planovalgus and Posterior Tibial Tendon Dysfunction Stage II: Review of 50 Feet in 39 Patients

Symptomatic flatfoot is a prevalent disorder. We undertook a review of 50 feet in 39 patients with flexible flatfoot treated between August 2000 and January 2008 in order to evaluate the modified Kidner-Cobb procedure. Overall clinical results were rated as good in 48 (96%) feet and fair in 2 (4%) feet, and there were no poor results. Average follow-up was 4.6 years, and total recovery time was 5.7 months in older patients and 3.7 months in children. Manual muscle-strength testing revealed no difference in tibialis anterior strength between the operated and contralateral extremity. All patients visually demonstrated postoperative elevation of the medial longitudinal arch height. Complications included 2 feet with wound dehiscence and 1 foot with fractured hardware. The results of this review indicate that the modified Kidner-Cobb procedure is a useful treatment option for patients with symptomatic flexible flatfoot with posterior tibial tendon dysfunction stage 2.

Lateral Column Lengthening for Acquired Adult Flatfoot Deformity Caused by Posterior Tibial Tendon Dysfunction Stage II: A Retrospective Comparison of Calcaneus Osteotomy with Calcaneocuboid Distraction Arthrodesis

In this study, clinical and radiological results after lateral column lengthening by calcaneocuboid distraction arthrodesis and calcaneus osteotomy were compared. Thirty-three patients (35 feet) treated with lateral column lengthening by distraction arthrodesis (14 patients, 16 feet; group I) or by calcaneus osteotomy (19 patients, 19 feet; group II) for adult-acquired flatfoot deformity caused by stage II posterior tibial tendon dysfunction were compared retrospectively. Mean follow-up was 42.4 months (range, 6-78 months) for group I and 15.8 months (range, 6-32 months) for group II (P < .001). The American Orthopaedic Foot & Ankle Society ankle-hindfoot score was determined, 4 variables were measured on preoperative and postoperative weight-bearing radiographs, and a number of independent and outcome variables, including patient satisfaction, were recorded. Group 2 had a significantly higher American Orthopaedic Foot & Ankle Society score compared with group I (mean, 85 vs. 72, respectively; P < .02) at time of last follow-up, and there were no dissatisfied patients in group I, whereas 2 patients in group II were dissatisfied with the result of the operation. All radiological results were significantly better at time of follow-up in both groups (except for talocalcaneal angle in group I), although no significant differences were noted in the amount of change in radiographic measurements between the groups. No significant correlation was found between follow-up time and radiographic improvement, indicating stable radiographic measurements over time. In group II, 13 mild calcaneocuboid subluxations were observed. In both groups, 1 nonunion and 1 wound complication occurred. Based on our experience with the patients described in this report, we recommend lateral column lengthening by means of calcaneus osteotomy rather than distraction arthrodesis of the calcaneocuboid joint, for correction of stage II posterior tibial tendon dysfunction.

Calcaneo-cuboid distraction arthrodesis combined with medial soft tissue reconstruction for posterior tibial tendon dysfunction stage II

Treatment of stage II posterior tibial tendon dysfunction (PTTD) is controversial. We performed a reconstructive operation in 14 patients with 16 flatfeet, all of which were stage II PTTD with unsatisfactory results after conservative therapy. The operation consisted of lengthening of the lateral column by bone-block arthrodesis of the calcaneo-cuboid (CC) joint, using a tricortical bone-block from the iliac crest. On the medial side, an augmentation of the posterior tibial tendon (PT) with the flexor digitorum longus tendon (FDL) was done, if the PT was intact. When the PT was torn, we performed a FDL transfer through the navicular bone. In all cases a percutaneous lengthening of the Achilles tendon was performed. We evaluated the results retrospectively, by follow up of all patients after a mean of 42 months after surgery. The AOFAS ankle/hindfoot score was determined and pre- and postoperative weight bearing radiographs were compared. Eighty-one percent of the patients were satisfied, and radiographs showed significant improvement. Three complications occurred: one case of non-union, one case of reflex sympathetic dystrophy, and one superficial woundinfection.We conclude that this reconstructive operation is a good treatment of stage II PTTD, when conservative treatment has failed.