Tib post Tendinopathy

Question 1

Anatomy
attachement

Answer 1

navicular tuberosity, cuboid, cuneiform, base of 2nd to 4th met and spring ligament.
Function

Question 2

function

Answer 2

• Inversion of STJ
• Dynamic stabilisation of hindfoot against valgus (EV) forces
• Support of MLA
• Locking TTJ allows gastroc to support heel raise and assist Achilles tendon in PF

Question 3

cause

Answer 3

overuse
- Excessive walking, running, jumping
- Excessive STJ PRO- inc eccentric tendon loading during SUP or TOE OFF

Question 4

Diagnosis

Answer 4

• Pain posterior to medial malleolus (ext towards midfoot and insertion to navicular)
• Tenderness along tendon
• Pain worse with WB, INV and PF against resistance
• “two many toes signs”
• Excessive pronation of affected foot
• Weakness of tib post – heel raise (assess for 10)- lack of hindfoot inv PTTD
• MRI- presence of tears

Question 5

Ddx

Answer 5

• Deltoid ligament sprain- (ligament testing- talar tilt)
• Tarsal tunnel syndrome (neuro symptoms)
• Navicular stress syndrome (MRI)
• posterior impingement (plain radiograph)
  -FHL tendinopathy (US)
• medial malleolus stress fracture (radiograph)

Question 6

Rx

Answer 6

• FW: stability shoe
• Orthoses: control pronation, medial heel skive (improve pronation control)
• INV strength- press against side table 3x 15 sec holds
• Eccentric exercises: pt stands on edge of step and drop downs into eversion

Question 7

biomechanics
Gait ax

Answer 7

lagging, rolling off medial collapsed
(late) midstance most symptomatic
STJ medially deviated
AJ ROM
Midfoot ROM
FF abduction
FPI - extent of condition

Question 8

patho

Answer 8

-load exceeds tendon capacity
overuse
exc STJ pronation- inc eccentric tendon loading during supination for toe off.
-tib post placed at lengthened pos and required to concentrically work harder and longer to resist pronation after heel strike. (Tib post firing longer, working at end ROM)
-pronated foot type are tensile load on tendons- harder to supinate
eccentric load thru tendon- fatigue quickly not controlling pronation well- get fast pronation no resupination- more muscle activation required to propel off ground

Question 9

short term

Answer 9

NSAIDS, activity mod (reducing load to alleviate symptoms) if acute. 2 weeks reduce activity- cross train- swimming etc.
stability shoe- firm medium post- tib post not working at end ROM i.e. New balance 860, basics kayano

Question 10

medium term

Answer 10

reduce pain, pain free
progressive concentric and eccentric tendon loading
theraband- inv strength- 30s x 4
calf raises w ABD foot - bias tip post (progressing to weighted)
calf raises w ball b/w feet- can’t drop ball (15x3) every 2nd day
anti pronation taping before orthotic
load tolerance to energy storage exercise that replicates demands of training based on pain tolerance.

Question 11

long term

Answer 11

12 weeks rehab then full return- tendon to heal
orthotics- medial heel skive apply force to calc traduce amount of pull on tib post- anti pronatory force. prevents exc Rfoot eversion
deep heel cups- inc stability i.e 16mm 20mm
thicker poly
skipping
stair climbing- pain?? progress to running 1min on 1 min off
8 10min. 5min 5 min
9
10
11 etc
tendon slow may take 3-4m to respond to loading program