Posterior Tibialis Tendon Dysfunction HUB 

GENERAL POSTERIOR TIBIALIS TENDON DYSFUNCTION (PTTD) INFORMATION

Posterior Tibialis Tendon Dysfunction - What is it?


The posterior tibial tendon serves as one of the major supporting structures of the arch of the human foot. Posterior tibial tendon dysfunction (PTTD) is a condition caused by changes in the tendon, impairing its ability to support the arch. This results in flattening of the medial arch of the foot. And can also lead the foot to turn outwards - or too many toes sign. PTTD is often called adult acquired flatfoot because it is the most common type of flatfoot developed during adulthood. PTTD is progressive, which means it will continue to worsen. Especially if it is not treated early. The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.




Posterior Tibialis Tendon Dysfunction - Why do I have it?


The cause of PTTD can be many different factors: Pain in the Tibialis Posterior is sometimes caused from the over working of the muscle itself from a biomechanical reason Histological examination has shown that, rather than tendinitis (tendon inflammation), the process is one of tendinosis (tendon degeneration), and the tibialis posterior tendon becomes fibrotic through a process of repeated microtrauma A poor blood supply to the tendon has been identified as it courses posterior to the medial malleolus.Mechanical factors must be at play that predispose the tendon to progressive fibrosis. A growing body of research proposes that abnormal forces arise from even mild flatfootedness, resulting in lifelong greater mechanical demands on the tibialis posterior than in a normal foot. Posterior Tibialis Tendon Dysfunction risk factors also include excessive weight gain, long periods of standing poor footwear change in loads (ie more steps) as well as hyper pronation syndromes. Conditions like diabetes, hypertension, obesity and previous ankle or foot trauma are all possible links to the condition At the Lower Extremity Group we also see a trend that correlates weakness in particular foot musculature. The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.




Posterior Tibialis Tendon Dysfunction - Some Simple Facts


Some simple facts: PTTD is the number 1 cause of adult acquired flatfoot deformity PTTD usually is one sided it is rare for it to be bilateral Prevalence is approximately 3% of the adult population Blood supply to the tendon is poorest in the area of injury Conditions like diabetes, hypertension, obesity and previous ankle or foot trauma are all possible links to the condition The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.




Posterior Tibialis Tendon Dysfunction - Anatomy, function and Facts?


First some brief anatomy. The tibialis posterior muscle originates on the inner posterior borders of the tibia and fibula. It is also attached to the interosseous membrane, which attaches to the tibia and fibula. Its tendon then descends behind the medial malleolus and terminates by dividing into a few portions. The plantar portion inserts into the bases of the second, third and fourth metatarsals, the second and third cuneiforms. The main portion inserts into the tuberosity of the navicular and the plantar surface of the first cuneiform. The main functions of the Tibialis posterior are: To decelerate Sub Talar Joint pronation & leg Internal Rotation. To assist the Soleus & long flexors with decelerating the forward momentum of the leg. To accelerate Sub Talar Joint supination & External Rotation of leg during mid-stance. To maintain stability of the Mid Tarsal Joint (supination around the Oblique Axis). To maintain the stability of all the lesser tarsal lesser tarsal & metatarsal bones To assist in heel lift by participating with the Soleus and long flexors to decelerate the forward motion of the tibia, & to simultaneously stop ankle joint dorsi-flexion The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.




Posterior Tibialis Tendon Dysfunction - Stages and Classification


Classification of PTTD: There are 4 stages of PTTD: (As per research article from Johnson and Strom) Tendon is inflamed Tendon becomes elongated The deformity becomes more rigid and degenerative changes are noted in sub taller joint Fixed deformity with degeneration in subtalar and ankle joints More specifically: Stage I - characterised by inflammation and/or degeneration of the tendon without compromise of the medial longitudinal arch. Pain is localised to the tendon. Tendon length, function, and hind/midfoot alignment are normal. Stage II - the diseased tendon elongates and a flexible flatfoot deformity develops, with hindfoot valgus, subtalar pronation and midfoot abduction. Stage III disease, the deformity becomes rigid. Stage IV disease, in which there is valgus tilt of the talus in the ankle mortise secondary to deltoid ligament laxity and/or arthrosis. The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.




Posterior Tibialis Tendon Dysfunction - How Can we be sure its PTTD?


How can we be sure its Tibialis Posterior Tendon Dysfunction and nothing else? The current gold standard for the clinical diagnosis of Tibialis Posterior Tendon Dysfunction includes a number of clinical observations and tests Poor unilateral Foot Function index scores Too many toes sign Single leg calf raise inability Poor isometric strength test result in plantar flexion and internal rotation of the foot in. Knee bent position. Palpation of the Tibialis Posterior tendon and muscle belly is usually performed by your doctor or therapist can be used to confirm the location of pain. Pain and/or swelling behind the medial malleolus and along the instep, Change in foot shape associated with decrease in walking ability and balance, Ultrasound scan of the Tibialis Posterior tendon can confirm a thickening of the various bands of the fascia also. Weightbearng X-rays are also used to confirm alignment of various foot bones and joints MRI can be used to assess degree of tendinosis The aim of this hub is to simplify the information found online into a concise reference of the facts of what to do, and how to do it, to help manage PTTD. If you need more information or would like a consultation please click below and we can organise one for you right away. These consults can be done in clinic or online via our state of the art software that runs our business and rehab programs. Also, just so you know we offer a 6 week online program for Posterior Tibialis Tendon Dysfunction. This program is amazing!!! You receive the exact rehab you will need to perform is delivered right to your smart device in video format each day. It will guide you through the exercises and enable you to begin to successfully manage Posterior Tibialis Tendon Dysfunction.





GOLD STANDARD POSTERIOR TIBIALIS TENDON TREATMENT

LEG - GOLD STANDARD for Posterior Tibialis Tendon dysfunction (PTTD) rehabilitation


The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation. We utilise a World Class rehabilitation program for Posterior Tibialis Tendon dysfunction (PTTD), and this is deilvered to you online in the comfort of your own home. All you have to do is follow our easy to use evidence based plan to treat and manage your Posterior Tibialis Tendon dysfunction (PTTD). This online program contains 12 complete weeks of revolutionary rehabilitation guides to help you manage and treat your Posterior Tibialis Tendon dysfunction (PTTD) every single day. We deliver our evidence-based daily Posterior Tibialis Tendon dysfunction (PTTD) injury management program via our amazing app, which is very easy for you to follow and includes;

  • Progressive neuromuscular exercises that will strengthen the muscles around the foot and ankle and help reduce the pain associated with Posterior Tibialis Tendon dysfunction (PTTD).
  • 5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
  • Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
  • ​Myofascial massage exercises
  • Using the app will enable you to understand when to apply the various exercises to help manage Posterior Tibialis Tendon dysfunction (PTTD)
  • Plus more
We offer online consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Posterior Tibialis Tendon dysfunction (PTTD). ​Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you to follow and complete. These are delivered daily to your smart device within our Posterior Tibialis Tendon dysfunction (PTTD) injury management program. Book in today - Online or in clinic





REHAB PROTOCOLS

Rehab Protocols


Posterior Tibialis Tendon Protocols Treating PTTD is possible. But there are NO MAGIC CURES!! No one off miracles that magically fix pain!!! YOU NEED TO USE AN EVIDENCE BASED TREATMENT PLAN It may not seem obvious, but you are guessing at what to do until you have a solid management program that contains exactly what you are required to do each and every day to help manage your PTTD. This is the most important step no matter what stage PTTD you have. Without a plan you are flying blind as to how to treat PTTD. Current research is indicates that we must base our treatment for this condition off similar protocols to those used for the treatment of tendinopathies in the human body. These plans involve a lot of research based evidence that supports the use of the therapeutic modalities we will instruct you on in our rehab program. These treatment plans are particularly important in the earlier stages of PTTD





RECOMMENDED MEDICAL LITERATURE

Posterior Tibialis Tendon Dysfunction: Overview of Evaluation and Management - Kaihan Yao, Timothy Xianyi Yang, Wei Ping Yew


Orthopedics. 2015 Jun;38(6):385-91. doi: 10.3928/01477447-20150603-06. https://pubmed.ncbi.nlm.nih.gov/26091214/ Abstract EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize posterior tibialis tendon dysfunction and begin to include it in differential diagnoses. 2. Recall the basic anatomy and pathology of the posterior tibialis tendon. 3. Assess a patient for posterior tibialis tendon dysfunction with the appropriate investigations and stratify the severity of the condition. 4. Develop and formulate a treatment plan for a patient with posterior tibialis tendon dysfunction. The posterior tibialis is a muscle in the deep posterior compartment of the calf that plays several key roles in the ankle and foot. Posterior tibialis tendon dysfunction is a complex but common and debilitating condition. Degenerative, inflammatory, functional, and traumatic etiologies have all been proposed. Despite being the leading cause of acquired flatfoot, it is often not recognized early enough. Knowledge of the anatomical considerations and etiology of posterior tibialis tendon dysfunction, as well as key concepts in its evaluation and management, will allow health care professionals to develop appropriate intervention strategies to prevent further development of flatfoot deformities.




Posterior Tibial Tendon Dysfunction: An Overview - Samuel Ka-Kin Ling , Tun Hing Lui


Open Orthop J. 2017 Jul 31;11:714-723. doi: 10.2174/1874325001711010714. eCollection 2017. https://pubmed.ncbi.nlm.nih.gov/28979585/ Abstract Background: Adult acquired flatfoot deformity is a commonly seen condition with a large clinical spectrum. It ranges from asymptomatic subjects to severely disabled arthritic patients. Posterior tibialis tendon dysfunction is a common cause of adult acquired flatfoot deformity. Methods: This article systematically reviews the published literature from books and journals that were either originally written or later translated into the English language regarding the subject of posterior tibialis tendon dysfunction. Results: Posterior tibialis tendon dysfunction is a primary soft tissue tendinopathy of the posterior tibialis that leads to altered foot biomechanics. Although the natural history of posterior tibialis tendon dysfunction is not fully known, it has mostly been agreed that it is a progressive disorder. While clinical examination is important in diagnosing adult acquired flat-feet; further investigation is often required to delineate the different aetiologies and stage of the disease. The literature describes many different management choices for the different stages of posterior tibialis tendon dysfunction. Conclusion: Because of the wide range of symptom and deformity severity, surgical reconstruction is based on a-la-carte. The consensus is that a plethora of reconstructive options needs to be available and the list of procedures should be tailored to tackle the different symptoms, especially when managing complex multi-planar reconstructions.




The effect of posterior tibialis tendon dysfunction on the plantar pressure characteristics and the kinematics of the arch and the hindfoot -  Carl W Imhauser et al


Clin Biomech (Bristol, Avon). 2004 Feb;19(2):161-9. doi:10.1016/j.clinbiomech.2003.10.007. https://pubmed.ncbi.nlm.nih.gov/14967579/ Abstract Objective: To study posterior tibialis tendon dysfunction using an in vitro model of the foot and ankle during the heel-off instant of gait. Background: Previous studies have concentrated primarily on the effect of posterior tibialis tendon dysfunction on the kinematics of the hindfoot and the arch. Methods: The specimens were loaded using a custom designed axial and tendon loading system and the location of the center of pressure was used to validate heel-off. Arch position, hindfoot position and plantar pressure data were recorded before and after the posterior tibialis tendon was unloaded. These data were recorded with the ligaments intact and after creating a flatfoot deformity. Results: Unloading the posterior tibialis tendon caused significant posterior movement in the center of pressure for the intact and flatfoot conditions. This also resulted in a medial shift in the force acting on the forefoot. The forefoot loads shifted medially after a flatfoot was created even when the posterior tibialis tendon remained loaded. The spatial relationships of the bones of the arch and the bones of the hindfoot also changed significantly for the intact specimen, and to a lesser extent after a flatfoot. Conclusions: The posterior tibialis tendon plays a fundamental role in shifting the center of pressure anteriorly at heel-off. Posterior tibialis tendon dysfunction causes posterior shift in the center of pressure and abnormal loading of the foot's medial structures. This may be the reason that posterior tibialis tendon dysfunction leads to an acquired flatfoot deformity. Conversely, flatfoot deformity may be a predisposing factor in the onset of posterior tibialis tendon dysfunction. This tendon also acts to lock the bones of the arch and the hindfoot in a stable configuration at heel-off, but a flatfoot deformity compromises this ability.