Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Foot and Ankle Research
Published in: Journal of Foot and Ankle Research 1/2018

Open Access 01-12-2018 | Review

Self-reported social and activity restrictions accompany local impairments in posterior tibial tendon dysfunction: a systematic review

Authors: Megan H. Ross, Michelle Smith, Melanie L. Plinsinga, Bill Vicenzino

Published in: Journal of Foot and Ankle Research | Issue 1/2018

Login to get access

Abstract

Background

Posterior tibial tendon dysfunction (PTTD) is a painful, progressive tendinopathy that reportedly predominates in middle-age, overweight women. There is no evidence based guidelines that clinicians can use to guide treatment planning, which leaves clinicians to make decisions on the basis of presenting clinical impairments and self-reported pain and disability. The purpose of this systematic review was to quantify clinical impairments, pain and disability in individuals with PTTD compared with controls.

Methods

Five databases were searched for terms referring to the posterior tibial tendon and flatfoot up to and including 11 March 2018. The systematic review was registered with PROSPERO (CRD: 42016046951). Studies were eligible if they were published in the English language and contained data on clinical impairments, pain or disability compared between participants diagnosed with PTTD and pain-free individuals. Standardised mean differences (SMDs) were calculated where possible and meta-analysis was performed when homogeneity of outcomes allowed.

Results

Ten eligible studies were identified and pooled in the meta-analyses. Strong effects were revealed for poor heel rise endurance (SMD -1.52, 95% CI -2.05 to − 0.99), less forefoot adduction-inversion strength (SMD -1.19, 95% CI -1.68 to − 0.71) and lower arch height (SMD -1.76, 95% CI -2.29 to − 1.23). Compared to controls, individuals with PTTD also had more self-reported stiffness (SMD 1.45, 95% CI 0.91 to 1.99), difficulties caused by foot problems (SMD 1.42, 95% CI 0.52 to 2.33) and social restrictions (SMD1.26, 95% CI 0.25 to 2.27).

Conclusion

There is evidence of impaired tibialis posterior capacity and lowered arch height in individuals with PTTD compared to controls. Further to addressing the expected impairments in local tendon function and foot posture, pain, stiffness, functional limitations and social participation restrictions should be considered when managing PTTD.
Appendix
Available only for authorised users
Literature
1.
Myerson MS. Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. J Bone Joint Surg Am. 1996;78(5):780–92.CrossRef
2.
Kohls-Gatzoulis J, Woods B, Angel JC, Singh D. The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England. Foot Ankle Surg. 2009;15(2):75–81.CrossRefPubMed
3.
Mann RA, Thompson FM. Rupture of the posterior tibial tendon causing flat foot. Surgical treatment. J Bone Joint Surg Am. 1985;67(4):556–61.
4.
Funk DA, Cass JR, Johnson KA. Acquired adult flat foot secondary to posterior tibial-tendon pathology. J Bone Joint Surg Am. 1986;68(1):95–102.CrossRefPubMed
5.
Kohls-Gatzoulis J, Angel J, Singh D. Tibialis posterior dysfunction as a cause of flatfeet in elderly patients. Foot. 2004;14(4):207–9.
6.
Kohls-Gatzoulis J, Angel JC, Singh D, Haddad F, Livingstone J, Berry G. Tibialis posterior dysfunction: a common and treatable cause of adult acquired flatfoot. BMJ. 2004;329(7478):1328–33.CrossRefPubMedPubMedCentral
7.
8.
Bluman EM, Title CI, Myerson MS. Posterior tibial tendon rupture: a refined classification system. Foot Ankle Clin. 2007;12(2):233–49.CrossRefPubMed
9.
Premkumar A, Perry MB, Dwyer AJ, Gerber LH, Johnson D, Venzon D, et al. Sonography and MR imaging of posterior tibial tendinopathy. AJR Am J Roentgenol. 2002;178(1):223–32.CrossRefPubMed
10.
Lim PS, Schweitzer ME, Deely DM, Wapner KL, Hecht PJ, Treadwell JR, et al. Posterior tibial tendon dysfunction: secondary MR signs. Foot Ankle Int. 1997;18(10):658–63.CrossRefPubMed
11.
Arangio GA, Waser T, Rogman A. Radiographic comparison of standing medial cuneiform arch height in adults with and without acquired flatfoot deformity. Foot Ankle Int. 2006;27(8):636–8.CrossRefPubMed
12.
Ellis SJ, Yu JC, Williams BR, Lee C, Chiu Y, Deland JT. New radiographic parameters assessing forefoot abduction in the adult acquired flatfoot deformity. Foot Ankle Int. 2009;30(12):1168–76.CrossRefPubMed
13.
Alvarez RG, Marini A, Schmitt C, Saltzman CL. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int. 2006;27(1):2–8.CrossRefPubMed
14.
Augustin JF, Lin SS, Berberian WS, Johnson JE. Nonoperative treatment of adult acquired flat foot with the Arizona brace. Foot Ankle Clin. 2003;8(3):491–502.CrossRefPubMed
15.
Houck J, Neville C, Tome J, Flemister A. Randomized controlled trial comparing crthosis augmented by either stretching or stretching and strengthening for stage II tbialis posterior tendon dysfunction. Foot Ankle Int. 2015;36(9):1006–16.CrossRefPubMed
16.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.CrossRefPubMedPubMedCentral
17.
Genaidy AM, Lemasters GK, Lockey J, Succop P, Deddens J, Sobeih T, et al. An epidemiological appraisal instrument - a tool for evaluation of epidemiological studies. Ergonomics. 2007;50(6):920–60.CrossRefPubMed
18.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMed
19.
20.
21.
22.
Neville C, Flemister AS, Houck JR. Deep posterior compartment strength and foot kinematics in subjects with stage II posterior tibial tendon dysfunction. Foot Ankle Int. 2010;31(4):320–8.CrossRefPubMedPubMedCentral
23.
Neville C, Flemister A, Tome J, Houck J. Comparison of changes in posterior tibialis muscle length between subjects with posterior tibial tendon dysfunction and healthy controls during walking. J Orthop Sports Phys Ther. 2007;37(11):661–9.CrossRefPubMed
24.
Houck J, Nomides C, Neville CG, Flemister AS. The effect of stage II posterior tibial tendon dysfunction on deep compartment muscle strength: a new strength test. Foot Ankle Int. 2008;29(9):895–902.CrossRefPubMedPubMedCentral
25.
Chimenti RL, Tome J, Hillin CD, Flemister AS, Houck J. Adult-acquired flatfoot deformity and age-related differences in foot and ankle Kknematics during the single-limb heel-rise test. J Orthop Sports Phys Ther. 2014;44(4):283–90.CrossRefPubMed
26.
Kulig K, Popovich JM Jr, Noceti-Dewit LM, Reischl SF, Kim D. Women with posterior tibial tendon dysfunction have diminished ankle and hip muscle performance. J Orthop Sports Phys Ther. 2011;41(9):687–94.CrossRefPubMed
27.
Neville C, Flemister AS, Houck J. Total and distributed plantar loading in subjects with stage II tibialis posterior tendon dysfunction during terminal stance. Foot Ankle Int. 2013;34(1):131–9.CrossRefPubMed
28.
Rabbito M, Pohl MB, Humble N, Ferber R. Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. J Orthop Sports Phys Ther. 2011;41(10):776–84.CrossRefPubMed
29.
Houck J, Neville CG, Tome J, Flemister A. Foot kinematics during a bilateral heel rise test in participants with stage II posterior tibial tendon dysfunction. J Orthop Sports Phys Ther. 2009;39(8):593–603.CrossRefPubMedPubMedCentral
30.
31.
Tome J, Nawoczenski DA, Flemister A, Houck J. Comparison of foot kinematics between subjects with posterior tibialis tendon dysfunction and healthy controls. J Orthop Sports Phys Ther. 2006;36(9):635–44.CrossRefPubMed
32.
Kulig K, Lee S-P, Reischl SF, Noceti-DeWit L. Effect of posterior tibial tendon dysfunction on unipedal standing balance test. Foot Ankle Int. 2015;36(1):83–9.CrossRefPubMed
33.
Deasy M, Leahy E, Semciw AI. Hip strength deficits in people with symptomatic knee osteoarthritis: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2016;46(8):629–39.CrossRefPubMed
34.
Lankhorst NE, Bierma-Zeinstra SMA, van Middelkoop M. Factors associated with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2013;47(4):193–206.CrossRefPubMed
35.
Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9–15.CrossRefPubMed
36.
Rathleff MS, Rathleff CR, Crossley KM, Barton CJ. Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med. 2014;48(14):1088.CrossRefPubMed
37.
Habets B, Smits DW, Backx FJG, van Cingel REH, Huisstede BMA. Hip muscle strength is decreased in middle-aged recreational male athletes with midportion Achilles tendinopathy: a cross-sectional study. Phys Ther Sport. 2016;25:55–61.CrossRefPubMed
38.
Ross MH, Smith MD, Vicenzino B. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: are they one and the same? A systematic review. PLoS One. 2017;12(12):e0187201.CrossRefPubMedPubMedCentral
39.
Shibuya N, Ramanujam CL, Garcia GM. Association of tibialis posterior tendon pathology with other radiographic findings in the foot: a case-control study. J Foot Ankle Surg. 2008;47(6):546–53.CrossRefPubMed
40.
Abousayed MM, Tartaglione JP, Rosenbaum AJ, Dipreta JA. Classifications in brief: Johnson and Strom classification of adult-acquired flatfoot deformity. Clin Orthop Relat Res. 2016;474(2):588–93.
Metadata
Title
Self-reported social and activity restrictions accompany local impairments in posterior tibial tendon dysfunction: a systematic review
Authors
Megan H. Ross
Michelle Smith
Melanie L. Plinsinga
Bill Vicenzino
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Foot and Ankle Research / Issue 1/2018
Electronic ISSN: 1757-1146
DOI
https://doi.org/10.1186/s13047-018-0292-z

Other articles of this Issue 1/2018

Journal of Foot and Ankle Research 1/2018 Go to the issue

Review

‘A good fit?’ Bringing the sociology of footwear to the clinical encounter in podiatry services: a narrative review

Review

Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review

Research

The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques

Research

Inverted Rearfoot posture in subjects with coexisting patellofemoral osteoarthritis in medial knee osteoarthritis: an exploratory study

Research

Multidisciplinary recommendations for diagnosis and treatment of foot problems in people with rheumatoid arthritis

Review

Sociology of the professions: what it means for podiatry