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Posterior tibial tendon dysfunction in children

Discussion in 'Pediatrics' started by tnm, Sep 4, 2012.

  1. tnm

    tnm Member

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    Hi everyone
    Sorry for such silly question...
    Does posterior tibial tendon dysfunction exist for children?

    Can we talk about PTTD looking at flexible pes planovalgus in children?

    Thanks alot for your post.
    Best regards!
  2. Re: Posterior tibial tendon dysfunction for children


    In children, the most common pathology regarding the posterior tibial (PT) tendon is an insertional tendinitis of the PT tendon onto the navicular tuberosity. I see this condition about twice a month in my office and is always associated with a child with a medially deviated subtalar joint (STJ) axis.

    In heavier children I may see some PT tendon tenderness associated with a medially deviated STJ axis, but never see the PT muscle weakness, PT tendon edema or a PT tendon tear/elongation that is seen prodominantly in women over the age of 50. My guess is that in children, the PT tendon is much more elastic than in older adults and that is the reason for the relative rarity of PT tendon tears (and Achilles tendon and peroneal tendon tears) in children versus older adults.

    Hope this helps.:drinks
  3. drsha

    drsha Banned

    It not only exists, it pre-exists, foot type-specific.

    In Foot Centering Theory, a functional foot typing performed on children exposes those who have a flexible rearfoot, flexible forefoot functional foot type as early as three years of age.
    There is generally a familial tendency to the same foot type as well as PTTD, "Flat feet", poor performance and postural collapse reported in adult family members, historically.

    Structurally, in addition to the elongation, widening and collapse that is occurring positionally during "normal" bone growth and soft tissue development of the flexible tie beam and its supporting muscle engines, there is biomechanical pathology that exists for that foot type that is not occurring in others, that produces additional elongation, widening and collapsed development of the flexible toe beam apparatus and the support system designed to maintain it.

    This additional elongation, widening and collapse within the structure of the foot is increasing abductory and plantarflectory moments within the medial column that tissue stresses the posterior tibial muscle engine causing the early and progressively, the late presentation of PTTD that Dr Kirby alludes to at its insertion into the navicular in children and along with its "pes valgo planus".

    Another development of this foot type is the progressive medial deviation of the STJ Axis that Dr Kirby witnesses when examining these rare patents (two a month he states) that is revealed earlier, better defined and more teachable by using Foot Centering than SALRE as SALRE focuses on only one of multitude of foot type-specific characteristics that have been documented here and elsewhere.

    I call this structural pathology that exists before bone growth ends Juvenile Tie Beam Expansion (JTBE) and when present, before, during or after the development of symptoms (insertional PT tendonitis in Dr Kirby's posting), demands foot centering treatment in order to correct this devastating biomechanical pathology non operatively and as early in the biomechanical timeline of any patient or family fated with this FFT.

    By using functional foot typing as a screening tool and by alerting parents and grandparents that have been functionally foot typed with the rearfoot flexible, forefoot flexible foot type, I and others have been able to gift many p more vague and difficult to accept by replacing them with FFTing.

    Researching a group of flexible rearfoot, flexible forefoot functional foot type children and adults would derive great insight and understanding of PTTD, postural collapse pathology in the knees and elsewhere and would IMHO be capable of being high level and biomechanically significant.

  4. tnm

    tnm Member

    Special thank to for Dr Kevin Kirby and drsha for clear answers.
    Best Regards.
  5. Bug

    Bug Well-Known Member

    Absolutely this!

    I have had one particular child with diagnosed PTD however she had a Type III, secondary navicular and the PT inserted into the secondary. The angles of pull were all wrong for her, she danced a great number of hours and in the end she not only had insertional pain, she had weakness and oedema. Long story but she went on to tear through the sheath following an injury and it tracked anterior to the malleoli.

    She had surgery, relocation and shortening and a number of other things. It is happening on her other foot now as well, poor kid. But the original foot is fabulous. So yes, I have seen it, but it is exceedingly rare and not for the same reasons that it occurs in adults.
  6. NewsBot

    NewsBot The Admin that posts the news.

    Full text (pfd) of case report of posterior tibial tendon dysfunction in a 10yr old:
    An important cause of pes
    planus: the posterior tibial
    tendon dysfunction

    Kemal Erol et al
    Clinics and Practice 2015; 5:699
  7. JenniferC

    JenniferC Member

    I have an 11 year old male patient with pes planus who is complaining of chronic heel pain. Initially I suspected Severs disease, or Achilles tendonitis as he has restricted triceps surae, however he has no pain with hopping, palpation of the Achilles or squeezing of the calcaneal apophysis.

    He had pain and weakness during while performing a single heel raise with the left foot, and was totally unable to perform a single heel raise with the right foot.

    Is it possible to have such severe Posterior Tibial Tendinopathy on a child? What other diagnoses should I consider?

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