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Posterior tibial tendon dysfunction or adult acquired flat foot?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Craig Payne, Dec 2, 2017.

  1. Craig Payne

    Craig Payne Moderator


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    In this thread on trends in Google search, this graph was posted on the trends in the frequency of the search terms 'Posterior tibial tendon dysfunction' or 'adult acquired flat foot'

    ie no one is using Google to search for 'adult acquired flat foot' !

    Kevin responded:
    Now we have this review:
    Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: Are they one and the same? A systematic review
    Megan H. Ross , Michelle D. Smith , Bill Vicenzino
    PLoS ONE 12(12): e0187201 December 1, 2017
    Last edited by a moderator: Dec 2, 2017
  2. "We recommend that PTTD is the preferred terminology for the condition associated with signs of local tendon dysfunction with pain and/or swelling along the tendon and difficulty with inversion and/or single leg heel raise characterising stage I and difficulty with single leg heel raise and a flexible flatfoot deformity characterizing stage II PTTD. "

    Thank you Ross, Smith and Vicenzino, you made my day. I'll keep my lectures titled "Posterior Tibial Tendon Dysfunction". This is a much better, and more specific term than "Adult Acquired Flatfoot"...kind of like the difference between "Plantar Plate Tear" and "Metatarsalgia"....:mad:
  3. The vast majority of authorities and researchers on this subject have long ago abandoned the term "PTTD" in favor of Adult Acquired Flatfoot. They have recognized the shortcomings of attributing this disorder primarily to attenuation or rupture of the posterior tibial tendon. A better classification system has been proposed which replaces the vague and misleading descriptions of Johnson and Strom which Ross, Smith and Vicenzino apparently endorse. For a more modern and certainly more appropriate classification system, please see:
    Steven L. Haddad, MD; Mark S. Myerson, MD; Alastair Younger, MD; Robert B. Anderson, MD; W. Hodge Davis, MD; Arthur Manoli, II, MD. Adult Acquired Flatfoot Deformity. Foot & Ankle International/Vol. 32, No. 1/January 2011
  4. markjohconley

    markjohconley Well-Known Member

    Dr Richie, which other tendon(s) could be dysfunctioning?, thanks
  5. Numerous studies have documented extensive ligament disruption in Stage 2 and 3 Adult Acquired Flatfoot which accounts for progression of deformity. Loss of integrity or function of the posterior tibial tendon alone cannot account for this progression of flatfoot deformity. Thus, the term PTTD is short sighted as it attributes the disorder to one single anatomic structure. Cadaver studies which to create a flatfoot model must release the spring ligament, the interosseous talocalcaneal ligament and the long plantar ligament before visible arch collapse and flatfoot deformity are observed. See:
    Richie DH. Biomechanics and Clinical Analysis of the Adult Acquired Flatfoot: in Clin Podiatr Med Surg 24 (2007) 617-644.
    Richie DH. Pathomechanics of the Adult Acquired Flatfoot: in Foot and Ankle Quarterly, Lepow GW Ed: Vol 17: 4: 109-124, 2005. Fall, 2005.
  6. markjohconley

    markjohconley Well-Known Member

    Thanks; are the Stage 2 'ruptures?' of , " ... the spring ligament, the interosseous talocalcaneal ligament and the long plantar ligament ...", a consequence of the Tibialis posterior tendon pathology of Stage 1?
  7. Yes, many agree that rupture of the posterior tibial tendon which probably occurs in Stage 1 or early Stage 2 ( Johnson and Strom classification) pre-disposes to rupture of other ligaments, and subsequent change in alignment and posture of the foot. One could argue that "dysfunction" of the posterior tibial tendon started the cascade of events, but there are certainly other contributing factors. Attributing the condition and deformity solely to this single anatomic structure ( the tib post tendon) is shortsighted in my opinion, which is shared by many authorities on this subject.
  8. efuller

    efuller MVP

    What other contributing factors would cause an adult acquired flat foot in the presence of an intact posterior tibial tendon?
  9. In Stage 2, 3 an 4 Adult Acquired Flatfoot, the posterior tibial tendon is NOT intact. There are rare cases reported, and I have seen a few myself where there is an isolated rupture of the spring ligament which has led to progressive flatfoot deformity. The vast majority of Adult Acquired Flatfoot have attenuation or rupture of the posterior tibial tendon.
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