Gait alterations in posterior tibial tendon dysfunction

NewsBot · Nov 13, 2019

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Gait alterations in posterior tibial tendonitis: A systematic review and meta-analysis
JunsigWangaErin M.MannenaSafeer F.SiddickyaJung-minLeebL. DanielLattc
Gait & Posture Volume 76, February 2020, Pages 28-38

Highlights
•Posterior tibial tendon dysfunction is a common and debilitating tendinopathy.
•This review summarized foot kinematics and kinetics in PTTD patients during gait.
•Eight studies were included in the meta-analysis.
•We found more conclusive changes in the forefoot and hindfoot kinematics.
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Background
Posterior tibial tendon dysfunction (PTTD) is a common and debilitating tendinopathy that can lead to a profound decrease in gait function. While the clinical diagnosis and treatment of this disorder are well described, the pathomechanics have not been adequately characterized. The purpose of this systematic review and meta-analysis is to compare foot/ankle kinematics and kinetics in patients with PTTD with healthy controls during gait.

Methods
Relevant articles were selected thought Medline (Pubmed), Scopus, CINAHL, and Web of Science. Studies focused on foot/ankle kinematics and kinetics in patients with PTTD were involved. Articles were included if they: 1) compared patients with PTTD to healthy controls, 2) utilized kinematics or kinetics as the primary outcome measure, 3) evaluated gait tasks, and 4) were written in English.

Results
Eleven articles were included in this systematic review, and 8 studies were synthesized and analyzed. Our meta-analyses indicated increased dorsiflexion and abduction of the forefoot, as well as increased plantarflexion and eversion of hindfoot for patients with PTTD during stance of walking.

Conclusion
Our results from the meta-analysis showed more conclusive changes in the forefoot (increased dorsiflexion and abduction) and hindfoot (increased plantarflexion and eversion) kinematics during stance of walking, which may be associated with a pathological process of PTTD. This review provides an improved understanding of gait function in patients with PTTD and preliminary knowledge for future research.
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Craig Payne · Nov 13, 2019

oh ffs!

Posterior tibial tendon dysfunction (PTTD) is a common and debilitating tendinopathy
Click to expand...

PTTD = older often overweight patients with progressive flatfoot; multiple structures involved.
PTT = younger active patient; overuse tendinopathy; no other structures involved

THEY NOT THE SAME THING!

Good study though!

NewsBot · Dec 11, 2021

In Vivo Analysis of Hindfoot Joints Movement During Stance Phase in
Stage Ⅱ Adult Acquired Flatfoot Deformity
Zhenhan Deng et al
Research Square

Background
This study aims to compare the kinematic characteristics of hindfoot joints of stage Ⅱ adult acquired flatfoot deformity (AAFD) and normal foot
through two-dimension (2D) -three-dimension (3D) registration technology and a single fluoroscopic imaging system, thus to provide research basis to
the pathogenesis, diagnosis and treatment of AAFD.
Methods
Then seven normal volunteers and eight volunteers with stage Ⅱ AAFD were recruited to take the CT scans for their bilateral feet in neutral positions,
after that their lateral dynamic X-ray data during stance phase were collected including fourteen normal feet and ten flatfeet. A computer-aided
simulated light source for 3D CT model was applied to obtain a virtual image, and it is matched with the dynamic X-ray images to make a registration
in “Fluo” software, by which finally the spatial changes during the stance phase can be calculated.
Results
In the early stage of touching the ground and the middle stage of standing, the extension and external rotation valgus of the navicular bone of the flat
foot was compared with that of the normal navicular bone, and there was no significant difference in the extension and external rotation valgus of the
calcaneus between the cuboid phase and the normal navicular bone. In the late stance phase, the degree of varus relative to the distance of the
navicular bone was smaller in the flat foot than in the normal foot but the degree of metatarsal flexion was not significantly different between the
cuboid and the calcaneus, and the degree of varus was smaller in the calcaneus but the degree of metatarsal flexion was greater.
Conclusion
During the early and mid-stance phase, there are excessive motion in the subtalar and talonavicular joints in stage Ⅱ AAFD. During the late stance
phase, the motion of subtalar and talonavicular joints are in the decompensated state. During the whole stance phase, the motion of calcaneocuboid
joint has no significant difference in both normal foot and stage Ⅱ AAFD.
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NewsBot · Dec 23, 2021

Posterior tibial tendon dysfunction alters the midfoot mechanics and energetics during gait
Sander Wuite et al
J Orthop Res. 2021 Dec 15

A comprehensive insight into the in-vivo foot kinetics of patients with posterior tibial tendon dysfunction (PTTD) is lacking to support clinical decision making. Our goal was to study how PTTD alters the kinetic and kinematic characteristics of the foot and ankle with a special focus on the midfoot joints. Multi-segment foot joint kinetics and kinematics were compared based on the Rizzoli foot model and inversed dynamics between a control group (n=25), patients with PTTD stage II (n=21) and PTTD stage III (n=4) over the entire stance phase. Compared to controls, a mean decrease in power generation in the Ankle joint was found in PTTD II patients of 1.3 W/kg (p<0.001) and PTTD III patients of 1.5 W/kg (p<0.001). In the Chopart joint there was a mean increase in power absorption in the PTTD III patients of 0.4 W/kg (p=0.014) and a mean decrease in power generation of 0.6 W/kg (p<0.001) in the PTTD II patients. The distribution of total negative work showed a shift from the Ankle and first metatarsal phalangeal joint towards the Chopart joint in both PTTD compared with the control subjects. A significant reduction in range of motion was observed among both PTTD groups. The outcome of this study will enable the possibility to customize the conservative and surgical treatment of each patient with PTTD, in order to improve or even restore the kinetic features. This will prevent the natural deterioration of function seen in this pathology.
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NewsBot · Feb 15, 2022

Postural Control Differences between Patients with Posterior Tibial Tendon Dysfunction and Healthy People during Gait
Junsig Wang et al
Int J Environ Res Public Health. 2022 Jan 24;19(3):1301

Background: Patients with posterior tibial tendon dysfunction (PTTD) may exhibit postural instability during walking likely due to a loss of medial longitudinal arch, abnormal foot alignment, and pain. While many studies have investigated gait alterations in PTTD, there is no understanding of dynamic postural control mechanisms in this population during gait, which will help guide rehabilitation and gait training programs for patients with PTTD. The purpose of the study was to assess dynamic postural control mechanisms in patients with stage II PTTD as compared to age and gender matched healthy controls.

Methods: Eleven patients with stage II PTTD (4 males and 7 females; age 59 ± 1 years; height 1.66 ± 0.12 m; mass 84.2 ± 16.0 kg) and ten gender and age matched controls were recruited in this study. Participants were asked to walk along a 10 m walkway. Ten Vicon cameras and four AMTI force platforms were used to collect kinematic and center of pressure (COP) data while participants performed gait. To test differences between PTTD vs. control groups, independent t-tests (set at α < 0.05) were performed.

Results: Patients with PTTD had significantly higher double stance ratio (+23%) and anterior-posterior (AP) time to contact (TTC) percentage (+16%) as compared to healthy control. However, PTTD had lower AP COP excursion (-19%), AP COP velocity (-30%), and medial-lateral (ML) COP velocity (-40%) as compared to healthy controls. Mean ML COP trace values for PTTD were significantly decreased (-23%) as compared to controls, indicating COP trace for PTTD tends to be closer to the medial boundary than controls during single-support phase of walking.

Conclusion: PTTD patients showed more conservative and cautious postural strategies which may help maintain balance and reduce the need for postural adjustment during PTTD gait. They also showed more medially shifted COP patterns than healthy controls during single-support phase of walking. Dynamic postural control outcomes could be used to develop effective gait training programs aimed at alleviating a medial shift of COP (everted foot) for individuals with PTTD in order to improve their functionality and gait efficiency.
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NewsBot · Apr 24, 2024

Lower limbs biomechanical deficits associated with stage 1 and 2 posterior tibialis tendon dysfunction during walking
Ahmed Dami et al
Gait & Posture Volume 110, May 2024, Pages 10-16

Highlights
•PTTD2 presented greater foot and ankle pronation than PTTD1.
•Medial longitudinal arch was more collapsed for PTTD2 than PTTD1.
•PTTD2 exhibited greater midfoot dorsiflexion/inversion and ankle plantarflexion/eversion.
•The lower limbs’ biomechanics was similar between PTTD1 and controls.
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Background
Posterior tibialis tendon dysfunction (PTTD) is a chronic degenerative musculoskeletal disorder causing a progressive ankle complex and arch collapse altering lower limb biomechanics. However, biomechanical changes associated with stage 1 and 2 PTTD need to be better characterized during walking to guide clinical recommendations and improve non-operative treatments.

Research question
What are the lower limb kinematic and kinetic differences between individuals with stage 1 (PTTD1), individuals with stage 2 PTTD (PTTD2) and healthy counterparts during gait?

Methods
Sixteen PTTD1, 11 PTTD2 and 20 healthy controls were included in this multicentric case-control study to compare their lower limb gait biomechanics. Kinematic and kinetic data were recorded using a three-dimensional motion capture system and a force plate. One-dimensional statistical parametric mapping was used to compare lower limb joint motion and moments between groups during the stance phase.

Results
PTTD1 had minimal biomechanical differences compared with the control group. In contrast, PTTD2 presented significant differences compared with controls and PTTD1. At the ankle, PTTD2 exhibited greater plantarflexion and eversion angles and midfoot dorsiflexion and inversion angles throughout stance compared with controls and PTTD1. PTTD2 presented lower midfoot abduction moments compared with controls. These changes led PTTD2 to exhibit knee and hip adaptative biomechanical mechanisms in the frontal and transverse planes in late stance. PTTD2 had greater knee internal rotation angles and smaller knee external rotation moments compared to controls. PTTD2 had smaller hip internal rotation angles compared with PTTD1 and smaller hip adduction moments compared with controls.

Significance
PTTD1 showed minimal biomechanical differences compared to controls and important differences compared to PTTD2. The lower limb biomechanical deficits accentuate as the pathology advances from stage 1 to stage 2. PTTD is a progressive condition needing early clinical management at stage 1 to avoid successive biomechanical changes associated with stage 2.
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