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Hi

I believe the evidence is still in question for the use of GTN patches in non-insertional/midportion Achilles tendinopathy- I've seen postive and negative studies. However, several people I've spoken to rate its use clinically.

Does anyone have any thoughts on using it with tibialis posterior pathology?

Ian

 

Hi Ian

There is some pretty high quality evidence for the use of TGN patches. Have you read these papers?

Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2007 Oct;28(10):1064-8.


Paoloni JA, Appleyard RC, Nelson J, Murrell GA Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004 May;86-A(5):916-22.

As for it's use in Tibialis Posterior.... You could make the link that it's use could be effective for tendon healing. It has been shown to be effective in supraspinatus tendon and lateral epicondalgia. However the main ingredient of care should involve biomechanical intervention to reduce the patholical loads that the tendon is placed under in the feet of people that suffer this disease.

The other issue with TGN patches is keeping them in place on the foot, inside a shoe.

Cheers

Luke

 

If GTN patches are effective for achilles tendinopathy then it would seem likely that they would be beneficial on any tendinopathy in which the same pathological processes are taking place. The only thing I can think of is that with tibialis posterior tendinopathy the location where the GTN patches would be applied are over fairly superficial, relatively large vessels e.g. posterior tibial artery. This could result in excess absorption of the GTN systemically resulting in increased incidence of systemic side effects including headache & hypotension. Just a thought.

 

Thanks Luke

Agree that it is only an adjunct therapy alongside orthotics/exercise.

I'd seen the initial study but I haven't looked at the follow-up- will check it out
The more negative study I've sen I found on another thread on pod arena.

Ian