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TIBIALIS POSTERIOR TENDON DYFUNCTION Evidence based Pathway - Coggle…
TIBIALIS POSTERIOR
TENDON DYFUNCTION
Evidence based Pathway
INITIAL
ASSESSMENT
SIGNIFICANT
HISTORY
over use injury
female>male
45+ years
high BMI
pes plano valgus
SIGNIFICANT FINDINGS
stage l-lV
pain around medial malleolus
low arch
tibialis posterior weakness
lateral impingment
SUGGESTING
ALTERNATIVES
inflammatory arthritis
history of trauma
radiating pain
neurological symptoms
loss of ankle inversion
against resistance
STAGES
Stage 1
tendon intact, inflamed
no deformity
mild swelling
Stage 2
tendon dysfunction
pes planus
difficulty with heel raise
Stage 3
degenerative changes
deformity becoming fixed
Stage 4 (Myerson)
valgus tilt of talus
lateral tibio-talar degeneration
ASSOCIATED FACTORS
age related degeneration
inflammatory arthritis
hypertension
diabetes mellitus
IMAGING
not indicated initially
US
MRI
FIRST LINE TREATMENT
orthoses
eccentric strengthening exercises
NSAIDs - oral or topical
footwear advice
strapping or taping
weight loss
IMPROVED
Continue treatment
until
symptoms resolved
NOT
IMPROVED
SECOND
LINE
TREATMENT
improve orthotic control
check compliance
AFO
cast immobilization (boot?)
NOT
IMPROVED
stages ll-lV
corticosteroid injection
NOT
IMPROVED
REFERRAL TO ORTHOPAEDICS
surgery
IMPROVED
IMPROVED
TREATMENT
NOT
CURRENTLY
RECOMMENDED
corticosteroid injection?
DIFFERENTIAL
DIAGNOSIS
navicular fracture
tarsal tunnel syndrome
tarsal coalition
FHL tendinopathy
FDL injury
medial ligament injury
neuromuscular pathology
hypermobility
os navicular
Charcot arthropathy
DEFINITION
common cause adult flat foot
tendon dysfuntion/failure
progressive