Post Tibial Tendonitis Flashcards
1
Q
Posterior Tibial Tendonitis Overview
A
- Most common cause of adult acquired flatfoot deformity
- Progressive and debilitatin disorder causing limitations in mobility, significant pain, and weakness
- Risk factors include HTN, obesity, diabetes, previous trauma, or steroid exposure
- This muscle runs on posterior leg and inserts on navicular tubercle
- Tendon passes behind medial malleolus
- This muscle acts as a primary dynamic stabilizer of medial longitudinal arch and main inventor of midfoot
2
Q
Posterior Tibial Tendonitis Stages
A
- Early stages = may be pain, area may be red and warm and swollen (not usually present during gait but can be during running)
- Later stages = arch begins to flatten, may be pain on inside of foot and ankle, foot and toes begin to turn outward and ankle rolls inward
- Advanced stages = arch flattens even more and pain shifts to outside of foot (below ankle), tendon deteriorated considerably, and arthritis develops
3
Q
Posterior Tibial Tendonitis Etiology
A
- Degeneration due to repetitive loading causing microtrauma
- Constriction beneath flexor retinaculum, abnormal anatomy of talus, degenerative changes associated with OA, and preexisting pes planus
4
Q
Posterior Tibial Tendonitis Clinical Presentation
A
- Slow, insidious onset of unilat flatfoot deformity
- Pain and swelling along medial aspect of foot and ankle, exacerbated with activity
- Standing on toes is painful and difficult
- Abnormal wear on shoes due to foot deformity
- Pes planus
- Impaired balance
- Impaired PF and inversion MMT
- Difficulty performing unilat heel raise
- Impaired subtalar mobility
5
Q
Posterior Tibial Tendonitis Gait
A
- Functions of healthy ankle is inversion, PF, and elevating medial longitudinal arch
- With this disease, other capsules and ligaments become weak — subtalar joint everts, foot abducts, and heel is in valgus
6
Q
Posterior Tibial Tendonitis Diagnosis
A
- Radiographs — for deformity and degenerative arthritis
- MRI has highest sensitivity and specificity BUT ultrasound is less expensive and almost as sensitive and specific as an MRI
- Single leg heel raise
- PF and inversion of foot against resistance
- Mobility
- Weightbearing xrays
- First metatarsal rise sign
7
Q
Posterior Tibial Tendonitis Stages
A
- Stage I — tendon intact and inflamed, no deformity, mild swelling
- Stage II — tendon dysfunctional, acquired pes planus but passively correctable, unable to perform heel raise
- Stage III — degenerative changes in subtalar joint, deformity is fixed (cant be passively corrected)
- Stage IV — valgus tilt of talus leading to lateral tibiotalar degeneration
8
Q
Posterior Tibial Tendonitis Examination
A
- Palpate tendon to asses pain and swelling
- Visual for pes planus
- Foot posture index
- Double leg heel rise (stages II-IV cannot do heel rise)
- Single leg heel rise (can’t do single leg heel rise with affected foot)
- First metatarsal rise sign — patient stands on both feet, shin of affected foot is taken with hand and rotated externally, head of metatarsal I is lifted if patient has PTTD
- PF and inversion against resistance
9
Q
Posterior Tibial Tendonitis Medical Management
A
- Stage 1 — NSAIDs and activity modification
- Stage 2 — immobilization through walking boot or cast for 3-4 weeks, custom molded orthotics or AFO if immobilization helps, and conservative therapy for 3-4 months and if that fails then surgery (osteotomy and debridement)
- Stage 3 — conservative treatment as mentioned above, surgery often warranted
- Stage 4 — conservative treatment as mentioned above, surgery often warranted
10
Q
Posterior Tibial Tendonitis PT Management
A
- Orthotic devices or bracing to support arch
- Achilles’ tendon stretching and tibialis posterior strengthing
- Immobilization
- Medications for pain and inflammation
- Shoe modifications such as inserts for arch
- Toe pick up exercises
- Arch strengthening
- Arch raises
