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Posterior Tibial Tendon Dysfunction - Coggle Diagram
Posterior Tibial Tendon Dysfunction
Tests
Too many toes sign.
Single heel raise. (unable to complete).
Ankle ligament testing.
Ottawa rules.
A. Bony tenderness along distal 6 cm of posterior edge of fibula or tip of lateral malleolus
B. Bony tenderness along distal 6 cm of posterior edge of tibia/tip of medial malleolus
C. Bony tenderness at the base of 5th metatarsal
D. Bony tenderness at the navicular
E. Inability to bear weight both immediately after injury and for 4 steps during intial evaluation
Squeeze test for fracture.
Tinel's test for nerves
Subjective
Risk factors include, obesity, T2D, hypertension and steroid use.
Insidious onset.
May have a limp and struggle with stairs and uneven surfaces.
Pain located around medial ankle and inner side of foot. Potentially report swelling.
Aggs include activities that use tendon: running, walking, hiking or climbing stairs.
Objective
Palpation = Tenderness over the tendon or on insertion.
During strength testing resisted inversion will elicit pain along tendon.
Observation: Swelling may be present. Visible flat foot when compared with other side.
Research
Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity. Bubra et al. 2015.
Overview of condition and presentation.
Anatomy, pathophysiology and classification
of posterior tibial tendon dysfunction. GUELFI et al 2017.
Details around pathophysiology and classification.
SW - Case study helped to inform.
Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines.
Ross et al 2018
Very limited literature so difficult to make conclusions.
Eccentric exercises may be superior for improving pain, disability and self-reported overall foot function than concentric exercises and foot orthoses and stretching alone.
Why this and nothing else?
Too many toes and unable to single foot heel raise.
Localised pain to medial aspect, whilst discountiong
Flattened arch.
Differentials
Ankle sprain.
Achilles tendinopathy.
Calf pathology.
Stress fracture.
Retrocalcaneal bursitis.
Pathology
Linked to flat foot deformity.
Progressive condition that without treatment can cause significant pain limit function and mobility.
Tibialis posterior is the muscle of the tendon effected - Main function is to invert foot and support medial longitudinal arch.
The degeneration of the tendon causes elongation and leads to a loss of mechanical advantage.
4 stages increasing in severity with the high stages.
Treatment
If the dysfunction is in a later stage surgery is a viable option.
Local tibialis posterior exercises (plantar flex and invert/evert), alignment and ankle stability.
Early recognition and orthotics are often key.