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Wednesday, March 12, 2014

Wednesday's Article of the Week: Posterior Tibial Tendon Dysfunction: Regaining Strength is Crucial

Posterior Tibial Tendon Dysfunction is a devastating injury. Stage II is when the damage is not too great and the chances for a good rehabilitation are great. It is so important to combine Phase I of rehabilitation: Immobilization and Anti-Inflammatory with Phase II: Restrengthening. Start restrengthening the tendon is what ever way possible as soon as you can, but it has to be pain free!!!

 2008 Sep;29(9):895-902. doi: 10.3113/FAI.2008.0895.

The effect of Stage II posterior tibial tendon dysfunction on deep compartment muscle strength: a new strength test.


Ithaca College - Rochester, Physical Therapy, 1100 South Goodman, Rochester, NY 14620, USA.



The purpose of this study was to compare isometric subtalar inversion and forefoot adduction strength in subjects with Stage II posterior tibial tendon dysfunction (PTTD) to controls.


Twenty four subjects with Stage II PTTD and fifteen matched controls volunteered for this study. A force transducer (Model SML-200, Interface, Scottsdale, AZ) was connected with a resistance plate and oscilloscope (TDS 410A, Tektronix, Beaverton, OR) to the foot. Via the oscilloscope, subjects were given feedback on the amount of force produced and muscle activation of the anterior tibialis (AT) muscle. Subjects were instructed to maintain a plantar flexion force while performing a maximal voluntary subtalar inversion and forefoot adduction effort. A two-way ANOVA model with the factors including, side (involved/uninvolved) and group (control/PTTD) was used.


The PTTD group on the involved side showed significantly decreased subtalar inversion and foot adduction strength (0.70 +/- 0.24 N/Kg) compared to the uninvolved side (0.94 +/- 0.24 N/Kg) and controls (involved side = 0.99 +/- 0.24 N/Kg, uninvolved side = 0.97 +/- 0.21 N/Kg). The average AT activation was between 11% to 17% for both groups, however, considerable variability in subjects with PTTD.


These data confirm a subtalar inversion and forefoot adduction strength deficit by 20% to 30% in subjects with Stage II PTTD. Although isolating the PT muscle is difficult, a test specific to subtalar inversion and forefoot adduction demonstrated the weakness in this population.


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