Mission Statement

Rock Valley Physical Therapy is dedicated to making better lives by fostering a timely, optimal outcome in a customer focused environment. Our highly skilled and compassionate team provides individualized one-on-one care for each patient. Our patients typically work with one therapist from start to finish. Every team member goes through extensive training and mentorship to ensure that each patient receives the highest level of care. At Rock Valley everything we have and everything we learn is about making better lives, one patient at a time.



We look forward to working with you!



- Amy, Luke, and Rachael



Disclaimer: This blog is intended for informational purposes only and is not to be considered medical advice. It is not intended to replace consultation with a licensed medical profession or qualify as physical therapy treatment. We are under no circumstance liable for advice given on this website.



Friday, September 2, 2011

Posterior Tibialis Tendon Dysfunction


The posterior tibialis tendon crosses the inside of the ankle joint, and works to control foot position during stance and walking.  Posterior tibialis dysfunction is the major cause of acquired flat foot deformity.1,2


Nearly 60% of patients with a rupture of the posterior tibialis tendon had 1 or more of the following symptoms: hypertension, obesity, diabetes mellitus, previous surgery or trauma in the medial aspect of the foot, or exposure to steroids.1

 

There are two main classifications within this disorder process:
Stage I: The tendon is of normal length, pain and swelling at medial foot
Stage II: Elongation of tendon, patient is unable to stand on toes of affected limb


What is the rehab role?

A study by Kulig et al examined the effectiveness of a 12 week program with custom -made orthotics in addition to stretching with or without an exercise program in adults with Stage I or II PTTD.  The study found that all interventions were effective in reducing pain; however the custom made orthotics along with eccentric exercises group had the most improvement in all subscales of foot functional index scores.3

A study by Alvarez et al found treating patients with Stage II PTTD with short articulating orthotics in combination with a high repetition ankle strengthening program showed significant improvements in VAS, single-support heel rise, ambulation distance, and strength.4

While being more expensive, custom articulating orthotics have been shown to provide best foot kinematics in gait, when compared to OTC or solid custom AFOs.6

Rehabilitation guidelines:3,4

  • Early stage (up to two weeks): Unload the tendon using orthotics, gastroc/soleus stretching, and build ambulation tolerance.
  • Middle stage (2-8 weeks): Recruit tibialis posterior, eccentric strengthening
  • Late stage (8-12 weeks): Progress toe walking to 150ft, progress ambulation distance to 2 miles, increase reps in HEP.

References:
Geideman WM, Johnson JE. Posterior Tibial Tendond Dysfunction. J Orthop Sports Phys Ther. 2000;30(2):68-77.
Trnka HJ. Dysfunction of the tendon of tibialis posterior.  J Bone Joint Surg [BR]. 2004;86-B:939-46.
Neville C et al. Choosing among 3 ankle-foot orthoses for a patient with Stage II posterior tibial tendon dysfunction. Journal of Ortho and Sports Phy Ther. 2009;39(11):816-824.
Alvarez RG et al. Stage I and II posterior tendon dysfunction treated by a structured nonoperative management protocol: an orthoses and exercises program. Foot & Ankle Internationional. 2006;27(1):2-8.
Kulig K et al. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot & Ankle International. 2009;30(9):877-855.
Franettovich M et al. A physiological and psychological basis for anti-pronation taping from a critical review of the literature. Sports Med 2008;38(8):617-631.


Posted by at
Subscribe to: Posts (Atom)