Frush TPPD

Question 1

Function and biomechanics of Posterior Tibialis M

Answer 1

• Powerful SUPINATOR
  
  • STJ
  • Oblique axis of midtarsal joint
• has some weak plantarflexion
• Supports LONGITUDINAL ARCH
• Decelerates leg internal rotation by ECCENTRIC CONTRACTION
• During MIDSTANCE CONCENTRIC CONTRACTION (STJ supination)

Question 2

DYSFUNCTION OF Posterior tibial tendon

Answer 2

• Cannot prevent excessive pronation
• talar head puts strain on spring ligament causing attenuation
• as arch collapses, deltoid strain can cause ANKLE VALGUS

Question 3

Common etiology

Answer 3

• Traumatic (rare)
• Degenerative
  
  • tendon hypo-vascularity
    
    • due to anatomy
    • due to DM, HTN, tobacco use

Question 4

Clinical presentation of Posterior tibialis tendon dysfunction

Answer 4

• Pain and swelling in medle ankle/midfoot
• loss of medial arch
• tendency to walk on inner border of the foot
• loss of push off/stength (can’t climb stairs)

Question 5

Clinical exam of TPPD

Answer 5

• too many toes signs
  
  • you see more toes on the lateral side of foot from behind
• single heel rise test
  
  • patient stands on one foot and attempts to rise up to toes (pain or heel inverts while rising)

Question 6

Testing of posterior tibial muscel strength exam

Answer 6

• place foot in platarflexed and inverted position
  
  • have patient hold position against resistance
  • evaluates for pain and/or muscle weakness

Question 7

AP radiograph of foot

Answer 7

• talocalcaneal (kites angle) = 17-21 degrees
• cuboid abduction angle = less than 5
• TALOR HEAD UNCOVERAGE
  
  • percentage of talor head uncovered by navicular
  • normal is less than 20%

Question 8

lateral AP of foot

Answer 8

• calcaneal inclination = normal 16-21 (TPPD would be less)
• talar declination = normal 21 (TPPD woulb be more)
• meary’s angle = normal 0-10 (TPPD would be higher)
• talocalcaneal = normal 15-35 (TPPD would be more)