Mechanical function of the tibialis posterior muscle

NewsBot · Aug 13, 2016

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The mechanical function of the tibialis posterior muscle and its tendon during locomotion
J.N. Maharaj, A.G. Cresswell, G.A. Lichtwark
Journal of Biomechanics; 8 August 2016

The tibialis posterior (TP) muscle is believed to provide mediolateral stability of the subtalar joint during the stance phase of walking as it actively lengthens to resist pronation at foot contact and then actively shortens later in stance to contribute to supination. Because of its anatomical structure of short muscle fibers and long series elastic tissue, we hypothesised that TP would be a strong candidate for energy storage and return. We investigated the potential elastic function of the TP muscle and tendon through simultaneous measurements of muscle fascicle length (ultrasound), muscle tendon unit length (musculoskeletal modeling) and muscle activation (intramuscular electromyography). In early stance, TP fascicles actively shortened as the entire muscle-tendon unit lengthened, resulting in the absorption of energy through stretch of the series elastic tissue. Energy stored in the tendinous tissue from early stance was maintained during mid-stance, although a small amount of energy may have been absorbed via minimal shortening in the series elastic elements and lengthening of TP fascicles. A significant amount of shortening occurred in both the fascicles and muscle-tendon unit in late stance, as the activation of TP decreased and power was generated. The majority of the shortening was attributable to shortening of the tendinous tissue. We conclude that the tendinous tissue of TP serves two primary functions during walking: 1) to buffer the stretch of its fascicles during early stance and 2) to enhance the efficiency of the TP through absorption and return of elastic strain energy
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Admin2 · Aug 13, 2016

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NewsBot · May 24, 2020

The tibialis posterior tendon footprint: an anatomical dissection study
Madeleine Willegger, Nargiz Seyidova, Reinhard Schuh, Reinhard Windhager & Lena Hirtler
Journal of Foot and Ankle Research volume 13, Article number: 25 (2020)

Background
The tibialis posterior tendon (TPT) is the main dynamic stabilizer of the medial longitudinal arch of the foot. Especially in adult acquired flatfoot deformity (AAFD) the TPT plays a detrimental role. The pathology and function of the tendon have been extensively investigated, but knowledge of its insertional anatomy is paramount for surgical procedures. This study aimed to analyze the complex distal footprint anatomy of the TPT.

Methods
Forty-one human anatomical specimens were dissected and the distal TPT was followed to its bony footprints. After tendon removal the footprints were marked with ink. Standardized photographs were taken and consecutively analyzed by digital imaging measurements. Footprint length, width, area of insertion, location, and shape was studied regarding the main insertion at the navicular bone.

Results
All specimens had the main TPT insertion at the navicular bone (41/41, 100%). Sixty-three percent of navicular TPT insertions were located at the plantar aspect. The mean navicular footprint measured 12.1 mm × 6.9 mm in length and width, respectively. The tendon further spread into several slips which anchored the tibialis posterior deep in the plantar arch. TPT insertions were highly variable with an involvement of up to eight distinct bony footprints in the mid- and hindfoot. The second most common additional footprint was the lateral cuneiform (93% of dissected feet), followed by the medial cuneiform (80%), the metatarsal bases [1–5] (80%), the cuboid (46%), the intermediate cuneiform (19%), and the calcaneus (12%).

Conclusions
The present study adds to current knowledge on the footprint anatomy of the TPT. Based on the findings of this study we advocate a plantar location of flexor digitorum longus tendon transfer in flexible AAFD in order to restore the anatomical lever and insertion of the TPT
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NewsBot · Dec 1, 2021

Clinical Significance of Anatomic Peculiarities and Ultrasound-Guided Electromyography of the Posterior Tibial Muscle
Fatma Elleuch et al
Cureus. 2021 Oct 12;13(10)

The posterior tibial muscle (PTM) is a key muscle in diagnosing the level of the neurologic lesion that causes steppage gate that is a paralysis of nervous origin of the muscles ensuring the foot dorsiflexion. The aim of this manuscript is to illustrate the anatomical peculiarities of the PTM, the ultrasound (US) anatomy of the infero-posterior part of the leg, and the technique of US-guided electro-neuro-myography (ENMG) of the PTM, which is considered a key muscle in the diagnosis of the neurological lesion causing steppage gate. The US-guided ENMG of the PTM is technically easy and safe for young practitioners provided there is a good knowledge of US anatomy of the infero-posterior part of the leg.
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NewsBot · Apr 5, 2022

Pseudo-tendinopathy on MRI of the navicular and tarsometatarsal parts of the tibialis posterior tendon: A study in normal individuals
Beyza Gungor et al
Eur J Radiol. 2022 Mar 9

Purpose: To determine the normal thickness and MRI appearance of the Tibialis Posterior Tendon near the navicular insertion in normal volunteers.

Materials and methods: By using a 3T MRI system 41 ankles were imaged, and PD weighted images with fat saturation were acquired in the three orthogonal planes. Symptoms of tendon pathology and history of trauma or surgery of the tendon were used as volunteer exclusion criteria. Two different measurement points were determined to evaluate hyperintensity and thickness. Two radiologists assessed the internal signal of the Tibialis Posterior Tendon independently by using axial and coronal images. Tendon hyperintensity was classified from homogenously dark to different degrees of hyperintense signal, where 0 means no internal hyperintensity, 1 - minimal hyperintensity, 2 - moderate and 3 - marked. Correlations between the two observers were obtained by Cohen's kappa. Descriptive statistics were also obtained.

Results: Eight men and 13 women (total 21) volunteers, age range 19-43(average 24.7)years were included in the study. At measurement point-1 on the coronal images, observer-1 and observer-2 evaluated hyperintensity (mostly minimal) respectively in 90.5% and 95.3% of tendons with a Cohen's kappa coefficient of 0.701 (moderate agreement) for the right foot and in 60% and 70% of tendons with a Cohen's kappa coefficient of 0.624 (moderate agreement) for the left foot. On axial images both observers assessed hyperintensity (mostly marked) in 100% of the tendons with a coefficient of 0.763 (moderate agreement) for the right foot, and in 95% of tendons with a coefficient of 0.839 (strong agreement) for the left foot. At measurement point-2 on coronal images, both observers rated any degree of hyperintensity in 33.3% of tendons with a coefficient of 1.00 (perfect agreement) for the right foot, in 38.9% of tendons with a coefficient of 0.766 (moderate agreement) for the left foot. On axial images both observers evaluated hyperintensity (mostly minimal) in 100% of tendons with a kappa coefficient of 0.702 (moderate agreement) for the right foot, in 95% of tendons with a coefficient of 0.790 (moderate- to strong agreement) for the left foot.

Conclusion: The Tibialis Posterior Tendon, near the navicular insertion (navicular tendon and tarsometatarsal tendon), exhibits an apparent thickening and most importantly hyperintensity which should be regarded as a normal finding, and not lead to an erroneous diagnosis of tendinopathy. This observation was almost always the case for the navicular insertion and less so for the tarsometatarsal tendon.
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