AFO's for posterior tibial tendon dysfunction

NewsBot · Jun 28, 2012

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Effect of Ankle-Foot Orthotic Devices on Foot Kinematics in Stage II Posterior Tibial Tendon Dysfunction.
Neville C, Lemley FR.
Foot Ankle Int. 2012 May;33(5):406-14.

BACKGROUND:
Data are limited on the various orthotic devices available for patients with Stage II posterior tibial tendon dysfunction (PTTD). Foot kinematics observed while walking with an orthotic device are hypothesized to be associated with clinical outcomes and could be used to refine future device designs.

METHODS:
Fifteen subjects (age, 63.6 ± 6.8 years) with Stage II PTTD walked in the lab under four conditions: (1) shoe only (control condition), (2) shoe with a custom solid AFO (Arizona Co, Mesa, AZ), (3) shoe with a custom articulated AFO (Arizona Co, Mesa, AZ), and (4) shoe with an off-the-shelf AFO (AirLift, DJ Orthopedics). Kinematic data were collected to determine the degree of hindfoot inversion, forefoot plantarflexion (reflective of raising the MLA), and forefoot adduction associated with each condition.

RESULTS:
The custom articulated device was associated with greater hindfoot inversion compared to the shoe only condition at loading response (p = 0.002), mid-stance (p < 0.001), and terminal stance (p = 0.02). The custom articulated device, custom solid device, and off-the-shelf device were associated with greater forefoot plantarflexion compared to the shoe only condition across all four phases of stance. There were no differences between any of the devices and the shoe condition associated with forefoot adduction.

CONCLUSION:
The custom devices were associated with greater hindfoot inversion and forefoot plantarflexion compared to walking with only a shoe, while the off-the-shelf device was associated with forefoot plantarflexion but no change in hindfoot motion. None of the devices corrected forefoot abduction compared to the shoe only condition.
CLINICAL RELEVANCE:
The current biomechanical data may aid in understanding the clinical outcomes seen using these devices as well as provide data to support new designs.
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Admin2 · May 3, 2021

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NewsBot · Oct 20, 2016

Biomechanical Analysis of UCBL/Articulated AFO in Stage II Posterior Tibial Tendon Dysfunction
Melissa Diamond, Alexander C. Bonner, Dennis Pedroso, Edward Milne, and Loren Latta
Foot & Ankle

Background: Weakening and partial rupture of the posterior tibial tendon (Stage II PTTD), is a common precursor to posterior tibial tendon rupture which leads to pes planus followed by a high probability of a need for surgical interventions and ultimately triple arthodesis. Early detection of the Stage II PTTD can prevent this vicious cycle of biomechanical failure. The goal of early intervention is to prevent pronation and valgus motion at the subtalar joint.
Hypothesis: An ankle-foot orthosis (AFO) with a UCBL footpiece and articulated ankle joint (UCBL/AFO) will maintain a physiological anatomical position of the hindfoot, midfoot, and forefoot without sacrificing free ankle range of motion in dorsiflexion and plantarflexion.
Methods: Four human cadaver legs had Stage II PTTDsimulated with a scalpel by the same surgeon (ACB) through a small incision over the medial aspect of the foot and ankle. Surgical classification of posterior tibial tendon rupture Type 11 is a partially torn, attenuated tendon. (Classification system with CT and MR imaging with surgical correlation. Radiology, 169: 229-235, 1988). Each leg was casted and a mold was modified upon which a UCBL/AFO was custom fabricated. Ten Nm dorsiflexion, plantarflexion, varus and valgus loads were applied to the cadaver foot while fluoroscopy imaged the positions of the subtalar joint/hindfoot complex both with and without the UCBL/AFO. Measurements were made from the images with Image pro software.
Results: The UCBL/AFO had minimal effect on sagittal ROM: 47.6º ± 19.8 without; and, 45.5º ± 21.6 with the UCBL/AFO. The UCBL/AFO controlled coronal plane ROM (p < 0.002): 27.0º ± 9.0 without; and, 9.7º ± 3.3 with the UCBL/AFO. The UCBL/AFO was most effective at reducing valgus motion: 19.4º ± 8.5 vs. 5.1º ± 1.1, which was only 27.7% ± 13.2% of the unsupported motion, (p < 0.002); compared to varus motion: 7.7º ± 2.5 vs. 5.6º ± 2.2, which was 74.3 ± 44.2%, (not significant).
Conclusions: The UCBL/AFO is a functional brace that effectively controls the pathological valgus motion that occurs in the subtalar joint/hindfoot complex when there is a stage II PTTD, while maintaining physiologic sagittal motion at the ankle joint and MTP joints. Level of Evidence: Not applicable, this was a biomechanical study in cadaver limbs.
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