Exercise for posterior tibial tendon dysfunction

NewsBot · Nov 9, 2018

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Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines
Megan H Ross, Michelle D Smith, Rebecca Mellor, Bill Vicenzino
BMJ Open Sport & Exercise Medicine 2018;4:e000430

Abstract
Objective To systematically review all randomised clinical trials to determine the efficacy of local strengthening exercises compared with other forms of conservative management for adults with posterior tibial tendon dysfunction.

Design Systematic review.

Data sources Four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase and PubMed) were searched up to June 2018.

Eligibility criteria for selecting studies The study included randomised clinical trials investigating individuals with posterior tibial tendon dysfunction where local strengthening was compared with other forms of conservative management with respect to pain, function and/or physical impairment outcome measures. Standardised mean differences (SMDs) were used to compare change scores between groups and descriptors of exercise prescription assessed according to the Template for Intervention Description and Replication and the Toigo and Boutellier recommendations.

Results 3 studies (n=93) were eligible for inclusion in the review. Varying strengthening exercises were compared with stretching and foot orthoses (n=2) or no intervention (n=1). Moderate effects (SMD 0.6–1.2) were found for reducing pain and disability with eccentric strengthening in conjunction with stretching and orthoses compared with concentric exercises, stretching and orthoses combined, and stretching and orthoses alone. Evaluation of exercise prescription parameters demonstrated minimal reporting, with the only consistent parameters being the number of sets and repetitions of the exercises, and the duration of the experimental period.

Conclusion This review demonstrates the paucity of high-quality research for the conservative management of posterior tibial tendon dysfunction, and highlights the lack of exercise prescription parameters reported in clinical trials.
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NewsBot · Apr 5, 2020

Effects of a 4-Week Short-Foot Exercise Program on Gait Characteristics in Patients With Stage II Posterior Tibial Tendon Dysfunction.
Kim J, Lee SC, Chun Y, Jun HP, Seegmiller JG, Kim KM, Lee SY.
J Sport Rehabil. 2020 Mar 31:1-9

CONTEXT:
Clinically, it has been suggested that increased activation of intrinsic foot muscles may alter the demand of extrinsic muscle activity surrounding the ankle joint in patients with stage II posterior tibial tendon dysfunction. However, there is limited empirical evidence supporting this notion.

OBJECTIVE:
The purpose of this study was to investigate the effects of a 4-week short-foot exercise (SFE) on biomechanical factors in patients with stage II posterior tibial tendon dysfunction.

DESIGN:
Single-group pretest-posttest.

SETTING:
University laboratory.

PARTICIPANTS:
Fifteen subjects (8 males and 7 females) with stage II posterior tibial tendon dysfunction who had pain in posterior tibial tendon, pronated foot deformity (foot posture index ≥+6), and flexible foot deformity (navicular drop ≥10 mm) were voluntarily recruited.

INTERVENTION:
All subjects completed a 4-week SFE program (15 repetitions × 5 sets/d and 3 d/wk) of 4 stages (standing with feedback, sitting, double-leg, and one-leg standing position).

MAIN OUTCOME MEASURES:
Ankle joint kinematics and kinetics and tibialis anterior and fibularis longus muscle activation (% maximum voluntary isometric contraction) during gait were measured before and after SFE program. Cohen d effect size (ES [95% confidence intervals]) was calculated.

RESULTS:
During the first rocker, tibialis anterior activation decreased at peak plantarflexion (ES = 0.75 [0.01 to 1.49]) and inversion (ES = 0.77 [0.03 to 1.51]) angle. During the second rocker, peak dorsiflexion angle (ES = 0.77 [0.03 to 1.51]) and tibialis anterior activation at peak eversion (ES = 1.57 [0.76 to 2.39]) reduced. During the third rocker, the peak abduction angle (ES = 0.80 [0.06 to 1.54]) and tibialis anterior and fibularis longus activation at peak plantarflexion (ES = 1.34 [0.54 to 2.13]; ES = 1.99 [1.11 to 2.86]) and abduction (ES = 1.29 [0.50 to 2.08]; ES = 1.67 [0.84 to 2.50]) decreased.

CONCLUSIONS:
Our 4-week SFE program may have positive effects on changing muscle activation patterns for tibialis anterior and fibularis longus muscles, although it could not influence their structural deformity and ankle joint moment. It could produce a potential benefit of decreased tibialis posterior activation.
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NewsBot · May 29, 2020

The Role of Exercise Therapies for the Management of Posterior Tibial Tendon Dysfunction

NewsBot · Jun 23, 2022

Comparison among Three Different Rehabilitation Programs on Outcomes of Patients with
Posterior Tibial Tendon Dysfunction
Rasha Ali Ahmed Abdelmowl et al
Tanta Scientific Nursing Journal

Background: Posterior tibial tendon dysfunction is a chronic, progressive, disabling condition of tendon
that adversely affects ankle, foot and lower limb function.Aim: Was to compare among three different
rehabilitation programs on outcomes of patients with posterior tibial tendon dysfunction. Subjects and
methods: Research design: Quasi-experimental design was used with a comparative study using
parallel-randomized groups (three intervention groups) with absence of control group. Subjects and
setting: The study included 60 patients with stage I posterior tibial tendon dysfunction attended to
orthopedic department and orthopedic outpatients clinic at Assiut University Hospitals. They randomly
assigned into 3 equal groups (20 for each) by using a computer based selection program; group (A)
muscle strengthening exercises and cold application, group (B) muscle strengthening exercises, medial
arch support insoles and contrast bath, and group (C) muscle strengthening exercises, medial arch
support insoles, ankle strengthening exercises and contrast bath. Tools: Patients assessment sheet, visual
analog scale, revised foot function index, short musculoskeletal functional assessment questionnaire and
exercises adherence logbook. Results: Pain level, revised foot function index scores, and short
musculoskeletal functional assessment questionnaire scores significantly decreased in all groups after
rehabilitation (p. value < 0.01). Group (C) demonstrated most improvement in each category followed by
group (B) while group (A) demonstrated least improvement. Conclusion: Muscle strengthening
exercises, medial arch support insoles, ankle strengthening exercises and contrast bath considered more
effective rehabilitation program in reducing pain and improving perceptions of function than other
rehabilitation programs. Recommendation: Rehabilitation should be considered within the first line of
managing patients with stage I posterior tibial tendon dysfunction.
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