Strengthening of the Posterior Tibial Tendon

https://youtu.be/w3FXx4OFqec

     One of the most severe problems that I treat is the wide spectrum of posterior tibial tendon problems. This can be from posterior tibial caused shin splints, posterior tibial tendonitis due to overuse with a new activity, or posterior tibial tendon failure in adults leading to flat foot. Therefore, anytime I have a patient whose problem is involving the posterior tibial tendon, I begin a life long strengthening program. 

     When a patient over pronates their foot, like in the photo here, they have alot of body parts to pick on.

Why do some patients have knee pain from the over pronation, some posterior tibial pain, some plantar fasciitis, ect? The answer lies I think in the Rule of 3. That means for most overuse injuries it actually takes 3 problems to cause the issue: You see the pronation problem, but a weakness in the posterior tibial tendon is also very common to find. I hope these exercises which isolate the injured tendon can help. 

Key words:

Posterior Tibial Tendon

Ankle Strengthening

Over Pronation

Posterior Tibial Tendon Strengthening: Ask The Podiatrist Segment 2

https://youtu.be/w3FXx4OFqec

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!!!



Foot Ankle Int. 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.

Houck JR, Nomides C, Neville CG, Samuel Flemister A.

Source

Ithaca College - Rochester, Physical Therapy, 1100 South Goodman, Rochester, NY 14620, USA. jhouck@ithaca.edu

Abstract

BACKGROUND:

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.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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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http://youtu.be/QP3Ud4d39dc

Navicular Drop Test for Posterior Tibial Dysfunction

This video is important for demonstrating both posterior tibial strengthening exercises and the navicular drop test for posterior tibial dysfunction.