scholarly journals A New Anatomical Classification for Tibialis Posterior Tendon Insertion and Its Clinical Implications: A Cadaveric Study

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1619
Author(s):  
Jeong-Hyun Park ◽  
Digud Kim ◽  
Hyung-Wook Kwon ◽  
Mijeong Lee ◽  
Yu-Jin Choi ◽  
...  
Keyword(s):  
Morphological Variability ◽  
Morphological Characteristics ◽  
Common Type ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Tibialis Posterior Tendon ◽  
Race And Gender ◽  
And Gender ◽  
Tendon Insertion

The variations in the tibialis posterior tendon (TPT) could not be defined by previous classification; thus, this study used a larger-scale cadaver with the aim to classify the types of TPT insertion based on the combination of the number and location of TPT insertions. A total of 118 feet from adult formalin-fixed cadavers were dissected (68 males, 50 females). The morphological characteristics and measurements of TPT insertion were evaluated. Four types of TPT insertions were classified, wherein the most common type was type 4 (quadruple insertions, 78 feet, 66.1%), which was divided into four new subtypes that were not defined in the previous classification. The second most common type was type 3 (triple insertions, 25 feet, 21.2%) with three subtypes, including the new subtype. Type 2 was found in 13 feet (11%), and the rarest type was type 1 (2 feet, 1.7%), wherein the main tendon was only attached to the navicular bone and the medial cuneiform bone. We suggest high morphological variability of the TPT in relation to the insertion location, along with the possibility of significant differences according to race and gender. Moreover, this classification will help clinicians understand adult flatfoot deformity-related posterior tibial tendon dysfunction (PTTD).

scholarly journals Efek Injeksi Plasma Kaya Platelet Terhadap Tenosinovitis Tendon Tibialis Posterior: Sebuah Studi Kasus

2019 ◽  
Vol 5 (1) ◽  
pp. 60-65
Author(s):  
Henry Ricardo Handoyo ◽  
Andryan Hanafi Bakri ◽  
Andri Primadhi Primadhi
Keyword(s):  
Platelet Rich Plasma ◽  
Tibialis Posterior ◽  
Medial Malleolus ◽  
Posterior Tibial Tendon ◽  
Foot And Ankle ◽  
Posterior Tibial Tendon Dysfunction ◽  
Flat Foot ◽  
Posterior Tibial ◽  
Left Ankle ◽  
History Of

Introduction: Posterior tibial tendon dysfunction is one of the most common, problems of the foot and ankle. Tenosynovitis of the posterior tibial tendon (PTT) is an often unrecognized form of PTT dysfunction. Case: A 54-year-old woman presented with left ankle pain that began while morning walk three days prior. She noted that the left ankle hurt with even light touch and the pain was unrelieved with sodium diclofenac. She denied any history of trauma. She was seen in the outpatient clinic for this condition. On examination, a three centimeter area of pain was found posterior to the medial malleolus and parallel to the PTT. She also had a stage I flat foot and mild soft tissue swelling around medial malleolus region on her radiograph examination. Ultrasound examination was done with the result of anechoic fluid visible in the peritendinous space around the PTT. The patient received diagnosis of PTT tenosynovitis, with the foot and ankle disability index (FADI) score was 58.7. Platelet rich plasma (PRP) injection was done twice with an interlude of two weeks. The pain subsided and the following FADI score was 84.6. Outcome: Patient showed improvement in her left ankle PTT tenosynovitis after two PRP injection. Conclusion: This case report highlights the efficacy of PRP as a modality in managing PTT tenosynovitis.

Effects of a 4-Week Short-Foot Exercise Program on Gait Characteristics in Patients With Stage II Posterior Tibial Tendon Dysfunction

2021 ◽  
Vol 30 (1) ◽  
pp. 120-128
Author(s):  
Jinah Kim ◽  
Sung Cheol Lee ◽  
Youngmin Chun ◽  
Hyung-Pil Jun ◽  
Jeffrey G. Seegmiller ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Tibialis Anterior ◽  
Muscle Activation ◽  
Stage Ii ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Foot Deformity ◽  
Posterior Tibial Tendon Dysfunction ◽  
Maximum Voluntary Isometric Contraction ◽  
Posterior Tibial

Context: Clinically, it has been suggested that increased activation of intrinsic foot muscles may alter the demand of extrinsic muscle activity surrounding the ankle joint in patients with stage II posterior tibial tendon dysfunction. However, there is limited empirical evidence supporting this notion. Objective: The purpose of this study was to investigate the effects of a 4-week short-foot exercise (SFE) on biomechanical factors in patients with stage II posterior tibial tendon dysfunction. Design: Single-group pretest–posttest. Setting: University laboratory. Participants: Fifteen subjects (8 males and 7 females) with stage II posterior tibial tendon dysfunction who had pain in posterior tibial tendon, pronated foot deformity (foot posture index ≥+6), and flexible foot deformity (navicular drop ≥10 mm) were voluntarily recruited. Intervention: All subjects completed a 4-week SFE program (15 repetitions × 5 sets/d and 3 d/wk) of 4 stages (standing with feedback, sitting, double-leg, and one-leg standing position). Main Outcome Measures: Ankle joint kinematics and kinetics and tibialis anterior and fibularis longus muscle activation (% maximum voluntary isometric contraction) during gait were measured before and after SFE program. Cohen d effect size (ES [95% confidence intervals]) was calculated. Results: During the first rocker, tibialis anterior activation decreased at peak plantarflexion (ES = 0.75 [0.01 to 1.49]) and inversion (ES = 0.77 [0.03 to 1.51]) angle. During the second rocker, peak dorsiflexion angle (ES = 0.77 [0.03 to 1.51]) and tibialis anterior activation at peak eversion (ES = 1.57 [0.76 to 2.39]) reduced. During the third rocker, the peak abduction angle (ES = 0.80 [0.06 to 1.54]) and tibialis anterior and fibularis longus activation at peak plantarflexion (ES = 1.34 [0.54 to 2.13]; ES = 1.99 [1.11 to 2.86]) and abduction (ES = 1.29 [0.50 to 2.08]; ES = 1.67 [0.84 to 2.50]) decreased. Conclusions: Our 4-week SFE program may have positive effects on changing muscle activation patterns for tibialis anterior and fibularis longus muscles, although it could not influence their structural deformity and ankle joint moment. It could produce a potential benefit of decreased tibialis posterior activation.

Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot

2018 ◽  
Vol 39 (7) ◽  
pp. 843-849 ◽  
Author(s):  
Emilio Wagner ◽  
Pablo Wagner ◽  
Diego Zanolli ◽  
Rubén Radkievich ◽  
Gunther Redenz ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Transfer ◽  
Soft Tissues ◽  
Distal Tibia ◽  
Tibialis Posterior ◽  
Control Group ◽  
Posterior Tibial Tendon ◽  
Tibialis Posterior Tendon ◽  
Foot Model ◽  
Tibialis Posterior Tendon Transfer

Background: Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). Methods: Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. Results: The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. Conclusion: The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.

Kidner Procedure for Symptomatic Accessory Navicular and Its Relation to Pes Planus

1995 ◽  
Vol 16 (8) ◽  
pp. 500-503 ◽  
Author(s):  
Somchai Prichasuk ◽  
Opas Sinphurmsukskul
Keyword(s):  
Pitch Angle ◽  
Normal Subjects ◽  
Tibialis Posterior ◽  
Medial Longitudinal Arch ◽  
Pes Planus ◽  
Tibialis Posterior Tendon ◽  
Accessory Navicular ◽  
Tendon Insertion

The role of relocation of tibialis posterior tendon insertion in the treatment of symptomatic accessory navicular and its relation to the pes planus was studied in 28 patients with symptomatic accessory navicular. Two hundred non-affected individuals were used as control. The calcaneal pitch angle measured radiographically, was used as an indicator of pes planus. All patients had had an excision of the accessory navicular and relocation of the tibialis posterior tendon insertion (Kidner procedure). The average follow-up was 3.2 years. The results were good in 27 patients, and fair in 1 patient, and there were no poor results. Most of the patients demonstrated that the pain and the fatigue signs of the foot and the leg have been improved. Only 3 of 25 patients clinically showed an improvement of the medial longitudinal arch. The calcaneal pitch angle in patients with symptomatic accessory navicular was significantly (14.8°) lower than that in normal subjects (21.4°). An association of pes planus and symptomatic accessory navicular was shown. The Kidner procedure gave good results in the relief of pain and fatigue in patients with symptomatic accessory navicular. The procedure did not significantly restore the height of the medial arch.

Calcification of the Tibialis Posterior Tendon: A Case Report and Literature Review

1995 ◽  
Vol 16 (12) ◽  
pp. 792-795 ◽  
Author(s):  
Marino Delmi ◽  
Anne-Marie Kurt ◽  
J.-M. Meyer ◽  
Pierre Hoffmeyer
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Tibialis Posterior Tendon ◽  
Posterior Tibial ◽  
Pathological Conditions

The tibialis posterior muscle and tendon are subject to a number of pathological conditions and injuries that have recently received much attention in the literature. Because of its function as a main stabilizer of the subtalar complex against hindfoot valgus and forefoot pronation, the mechanical demand on the posterior tibial tendon is high. Problems with dislocation, tenosynovitis, rupture, and laceration have all been described with this tendon. In this report, we present a case of dysfunction of the posterior tibial tendon associated with chronic tendinitis and intratendinous calcifications. After removal of the calcifications, the patient became asymptomatic and returned to work. Proposed etiologies of these calcifications are discussed.

scholarly journals Nonsurgical Management of Posterior Tibial Tendon Dysfunction With Orthoses and Resistive Exercise: A Randomized Controlled Trial

2009 ◽  
Vol 89 (1) ◽  
pp. 26-37 ◽  
Author(s):  
Kornelia Kulig ◽  
Stephen F Reischl ◽  
Amy B Pomrantz ◽  
Judith M Burnfield ◽  
Susan Mais-Requejo ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Tibialis Posterior ◽  
Posterior Tibial Tendon ◽  
Walk Test ◽  
Functional Index ◽  
Posterior Tibial Tendon Dysfunction ◽  
Post Intervention ◽  
Early Management ◽  
Resistive Exercise ◽  
Minute Walk

Background and PurposeTibialis posterior tendinopathy can lead to debilitating dysfunction. This study examined the effectiveness of orthoses and resistance exercise in the early management of tibialis posterior tendinopathy.SubjectsThirty-six adults with stage I or II tibialis posterior tendinopathy participated in this study.MethodsParticipants were randomly assigned to 1 of 3 groups to complete a 12-week program of: (1) orthoses wear and stretching (O group); (2) orthoses wear, stretching, and concentric progressive resistive exercise (OC group); or (3) orthoses wear, stretching, and eccentric progressive resistive exercise (OE group). Pre-intervention and post-intervention data (Foot Functional Index, distance traveled in the 5-Minute Walk Test, and pain immediately after the 5-Minute Walk Test) were collected.ResultsFoot Functional Index scores (total, pain, and disability) decreased in all groups after the intervention. The OE group demonstrated the most improvement in each subcategory, and the O group demonstrated the least improvement. Pain immediately after the 5-Minute Walk Test was significantly reduced across all groups after the intervention.Discussion and ConclusionPeople with early stages of tibialis posterior tendinopathy benefited from a program of orthoses wear and stretching. Eccentric and concentric progressive resistive exercises further reduced pain and improved perceptions of function.

Clear Cell Sarcoma of the Distal Tibialis Posterior Tendon Insertion: A Case Report

2008 ◽  
Vol 29 (4) ◽  
pp. 445-448 ◽  
Author(s):  
Charlie R. J. Jowett ◽  
Warren Davis ◽  
Adrienne Flanagan ◽  
Ali Bayan ◽  
Nick Cullen
Keyword(s):  
Case Report ◽  
Clear Cell ◽  
Clear Cell Sarcoma ◽  
Tibialis Posterior ◽  
Tibialis Posterior Tendon ◽  
Cell Sarcoma ◽  
Tendon Insertion

Referral Patterns for Youths Identified at Risk for Suicide by Trained Gatekeepers

Crisis ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Michael S. Rodi ◽  
Lucas Godoy Garraza ◽  
Christine Walrath ◽  
Robert L. Stephens ◽  
D. Susanne Condron ◽  
...  
Keyword(s):  
Suicide Prevention ◽  
Demographic Characteristics ◽  
Service Access ◽  
Referral Patterns ◽  
Race And Gender ◽  
Lee Smith ◽  
Prevention Behavior ◽  
Key Variables ◽  
And Gender ◽  
To Receive

Background: In order to better understand the posttraining suicide prevention behavior of gatekeeper trainees, the present article examines the referral and service receipt patterns among gatekeeper-identified youths. Methods: Data for this study were drawn from 26 Garrett Lee Smith grantees funded between October 2005 and October 2009 who submitted data about the number, characteristics, and service access of identified youths. Results: The demographic characteristics of identified youths are not related to referral type or receipt. Furthermore, referral setting does not seem to be predictive of the type of referral. Demographic as well as other (nonrisk) characteristics of the youths are not key variables in determining identification or service receipt. Limitations: These data are not necessarily representative of all youths identified by gatekeepers represented in the dataset. The prevalence of risk among all members of the communities from which these data are drawn is unknown. Furthermore, these data likely disproportionately represent gatekeepers associated with systems that effectively track gatekeepers and youths. Conclusions: Gatekeepers appear to be identifying youth across settings, and those youths are being referred for services without regard for race and gender or the settings in which they are identified. Furthermore, youths that may be at highest risk may be more likely to receive those services.

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