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Structures involved in posterior tibial tendon dysfunction

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  #1  
Old 27th April 2012, 01:28 PM
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Default Structures involved in posterior tibial tendon dysfunction

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Posterior tibial tendon dysfunction: what other structures are involved in the development of acquired adult flat foot?
Herráiz Hidalgo L, Carrascoso Arranz J, Recio Rodríguez M, Jiménez De La Peña M, Cano Alonso R, Alvarez Moreno E, Martínez De Vega Fernández V.
Radiologia. 2012 Apr 23
Quote:
OBJECTIVE:
To evaluate the association of posterior tibial tendon dysfunction and lesions of diverse ankle structures diagnosed at MRI with radiologic signs of flat foot.

MATERIAL AND METHODS:
We retrospectively compared 29 patients that had posterior tibial tendon dysfunction (all 29 studied with MRI and 21 also studied with weight-bearing plain-film X-rays) with a control group of 28 patients randomly selected from among all patients who underwent MRI and weight-bearing plain-film X-rays for other ankle problems. In the MRI studies, we analyzed whether a calcaneal spur, talar beak, plantar fasciitis, calcaneal bone edema, Achilles' tendinopathy, spring ligament injury, tarsal sinus disease, and tarsal coalition were present. In the weight-bearing plain-film X-rays, we analyzed the angle of Costa-Bertani and radiologic signs of flat foot. To analyze the differences between groups, we used Fisher's exact test for the MRI findings and for the presence of flat foot and analysis of variance for the angle of Costa-Bertani.

RESULTS:
Calcaneal spurs, talar beaks, tarsal sinus disease, and spring ligament injury were significantly more common in the group with posterior tibial tendon dysfunction (P<.05). Radiologic signs of flat foot and anomalous values for the angle of Costa-Bertani were also significantly more common in the group with posterior tibial tendon dysfunction (P<.001).

CONCLUSION:
We corroborate the association between posterior tibial tendon dysfunction and lesions to the structures analyzed and radiologic signs of flat foot. Knowledge of this association can be useful in reaching an accurate diagnosis.
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Old 28th April 2012, 06:20 AM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Quote:
CONCLUSION:
We corroborate the association between posterior tibial tendon dysfunction and lesions to the structures analyzed and radiologic signs of flat foot. Knowledge of this association can be useful in reaching an accurate diagnosis.
Oh yeah, like if you arrive home and examine the fridge and its crushed and you notice that most of the bricks are not joined together and the stairway leads up to a gaping hole and the bathroom is in the garden then I can corroborate the association between these findings and your house falling down. Knowledge of this association can be useful in reaching for a bottle of scotch.

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Old 4th July 2012, 09:02 AM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Dynamic effect of the tibialis posterior muscle on the arch of the foot during cyclic axial loading.
Kamiya T, Uchiyama E, Watanabe K, Suzuki D, Fujimiya M, Yama****a T.
Clin Biomech (Bristol, Avon). 2012 Jun 30
Quote:
BACKGROUND:
The most common cause of acquired flatfoot deformity is tibialis posterior tendon dysfunction. The present study compared the change in medial longitudinal arch height during cyclic axial loading with and without activated tibialis posterior tendon force.

METHODS:
Fourteen normal, fresh frozen cadaveric legs were used. A total of 10,000 cyclic axial loadings of 500N were applied to the longitudinal axis of the tibia. The 32-N tibialis posterior tendon forces were applied to the specimens of the active group (n=7). Specimens of another group (non-active group, n=7) were investigated without the tibialis posterior tendon force. The bony arch index was calculated from the displacement of the navicular height.

FINDINGS:
The mean initial bony arch indexes with maximal weightbearing were 0.239 (SD 0.009) in active group and 0.239 (SD 0.014) in non-active group. After 7000cycles, the bony arch indexes with maximal weightbearing were significantly greater in the active group (mean 0.214, SD 0.013) than in the non-active group (mean 0.199, SD 0.013). The mean bony arch indexes with maximal weightbearing after 10,000cycles were 0.212 (SD 0.011) in the active group and 0.196 (SD 0.015) in the non-active group.

INTERPRETATION:
The passive supportive structures were inadequate, and the tibialis posterior muscle was essential to maintain the medial longitudinal arch of the foot in the dynamic weightbearing condition. The findings underscore that physical therapy and arch supportive equipments are important to prevent flatfoot deformity in the condition of weakness or dysfunction of the tibialis posterior muscle.
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Old 4th September 2012, 01:11 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Posterior tibial tendon dysfunction and flatfoot: Analysis with simulated walking.
Watanabe K, Kitaoka HB, Fujii T, Crevoisier X, Berglund LJ, Zhao KD, Kaufman KR, An KN.
Gait Posture. 2012 Aug 29.
Quote:
Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.
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Old 9th April 2013, 12:23 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Isolated Spring Ligament Failure as a Cause of Adult-Acquired Flatfoot Deformity.
Orr JD, Nunley JA 2nd.
Foot Ankle Int. 2013 Apr 5.
Quote:
BACKGROUND:
Adult-acquired flatfoot deformity is usually secondary to failure of the tibialis posterior tendon, with secondary injury to the surrounding osseous-ligamentous complex. Rarely, patients may present with a normal tibialis posterior tendon and an isolated injury of the plantar calcaneonavicular, or spring, ligament. The current study describes the clinical presentation and operative management of 6 patients with isolated spring ligament ruptures who presented with symptomatic flexible flatfoot deformities.

METHODS:
Six consecutive patients with unilateral flatfoot deformities secondary to spring ligament failure were operatively treated at one institution between 2003 and 2010. All patients presented with symptomatic flatfoot deformities recalcitrant to conservative management. No patients had previous flatfoot reconstructive surgery, but all had undergone some combination of orthotic use, immobilization, or activity modifications prior to operative treatment. In each case, intraoperative findings demonstrated a tear of the spring ligament complex with a normal tibialis posterior tendon. To address the deformities, spring ligament repairs and adjunctive flatfoot reconstructions were performed. A retrospective chart study was performed to document patient presentation, demographics, and outcomes.

RESULTS:
Average patient age was 42 years. All 6 patients were female. All patients presented with medial foot pain for a mean of 27 months prior to presentation. Spring ligament abnormality was demonstrated in all 5 patients who received preoperative magnetic resonance imaging. Intraoperatively, all 6 patients demonstrated spring ligament tears and no significant tibialis posterior tendon abnormality. All 6 patients underwent spring ligament repairs with or without adjunctive flatfoot reconstructions. At mean follow-up of 13 months, all but 1 patient were pain-free without orthotics, and all patients were without residual deformity. There was a single patient with delayed bone graft healing and no other minor or major complications in this series.

CONCLUSIONS:
Adult-acquired flatfoot deformity is usually secondary to tibialis posterior tendon failure but in rare cases may be secondary to isolated spring ligament injury without tibialis posterior tendon abnormality. This unique clinical entity should be considered in patients who present with flatfoot deformities. In this study, although preoperative magnetic resonance imaging was not required, it identified a suspected spring ligament tear in all cases in which it was used. Thorough intraoperative exploration can identify an injury to the spring ligament and a normal tibialis posterior tendon. Failure to recognize an isolated spring ligament injury as the primary cause of a flatfoot deformity could lead to inappropriate operative management.
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Old 2nd September 2013, 03:30 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Validation of a population of patient-specific adult acquired flatfoot deformity models
E. Meade Spratley, Erika A. Matheis, Curtis W. Hayes, Robert S. Adelaar, Jennifer S. Wayne
Journal of Orthopaedic Research; Early View
Quote:
Adult acquired flatfoot deformity (AAFD) is a degenerative disease resulting in malalignment of the mid- and hindfoot secondary to posterior tibial tendon dysfunction and increasing implication of ligament pathologies. Despite the complex 3D nature of AAFD, 2D radiographs are still employed to diagnose and stage the disease. Computer modeling techniques allow for accurate 3D recreations of musculoskeletal systems for the investigation of biomechanical factors contributing to disease. Following Institutional Review Board approval, the lower limbs of six diagnosed AAFD sufferers were imaged with MRI, photographs, and X-ray. Next, a radiologist graded the MRI attenuation of eight soft-tissues implicated in AAFD. Six patient-specific rigid-body models were then created and loaded according to patient weight, graded soft-tissues, and extrinsic muscles. Model function was validated using clinically relevant kinematic measures in three planes. Agreement varied depending on the measure, with average absolute deviations of <7° for angles and <4 mm for distances. Additionally, the clinically favored AP talonavicular coverage angle, ML talo-1st metatarsal angle, and ML 1st cuneiform height showed strong correlations of R2 = 0.63, 0.75, and 0.85, respectively. Thus, computer modeling offers a promising methodology for the non-invasive investigation of in vivo kinematic behavior in pathologic feet and, once validated, may further be used to investigate biomechanical parameters that are difficult to measure clinically
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Old 21st February 2014, 11:14 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Could Failure of the Spring Ligament Complex Be the Driving Force behind the Development of the Adult Flatfoot Deformity?
Geraint Williams, James Widnall, Paul Evans, Simon Platt
The Journal of Foot and Ankle Surgery Volume 53, Issue 2, March–April 2014, Pages 152–155
Quote:
We conducted an investigation into the relative associations of magnetic resonance imaging (MRI)–defined pathologic features of the spring ligament and/or tibialis posterior tendon with radiographic evidence of a planovalgus foot position. A total of 161 patient images (MRI and plain radiographs) obtained from the foot and ankle clinic (2008 to 2011) were retrospectively reviewed. All 161 patients (64 male and 97 female; mean age 45.9 years, range 18 to 86) were included in the analysis. Lateral weightbearing radiographs were analyzed for the talo–first metatarsal angle ≥ 5°, calcaneal pitch ≤ 20°, and talocalcaneal angle ≥ 45°. A positive finding for ≥ 1 measurements identified a radiographic planovalgus position of the foot. The radiographic deformity was analyzed against the MRI evidence of either spring ligament or tibialis posterior tendon pathologic features for significance (p < .05). Evidence of a spring ligament abnormality was strongly associated with a planovalgus foot position, reaching high levels of statistical significance in all 3 categories of radiographic deformity (odds ratio 9.2, p < .0001). Abnormalities of the tibialis posterior tendon failed to demonstrate significance, unless grade I changes were excluded, and grade II and III appearances were analyzed in isolation (odds ratio 2.9, p = .04). Although absolute causal relationships were not tested, this investigation has clearly demonstrated that MRI-defined abnormalities of the spring ligament complex are possibly of at least equal importance to tibialis posterior dysfunction for the presence of a moderate to severe radiographic planovalgus foot position.
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Old 21st February 2014, 11:15 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

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Originally Posted by NewsBot View Post
Could Failure of the Spring Ligament Complex Be the Driving Force behind the Development of the Adult Flatfoot Deformity?
Geraint Williams, James Widnall, Paul Evans, Simon Platt
The Journal of Foot and Ankle Surgery Volume 53, Issue 2, March–April 2014, Pages 152–155
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Role of the spring ligament
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Old 21st April 2014, 08:11 PM
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Default Re: Structures involved in posterior tibial tendon dysfunction

Comparison of Deformity with Respect to the Talus in Patients with Posterior Tibial Tendon Dysfunction and Controls Using Multiplanar Weight-Bearing Imaging or Conventional Radiography
Amgad M. Haleem, MD; Helene Pavlov, MD; Eric Bogner, MD; Carolyn Sofka, MD; Jonathan T. Deland, MD; Scott J. Ellis, MD
J Bone Joint Surg Am, 2014 Apr 16;96(8):e63 1-8. doi: 10.2106/JBJS.L.01205
Quote:
Background:
Posterior tibial tendon dysfunction varies in location and severity. Weight-bearing radiographs have been validated to assess posterior tibial tendon dysfunction, yet their two-dimensional nature and the inability of the patients to achieve full weight-bearing during acquisition are limitations. Multiplanar modified sectional weight-bearing imaging is a novel modality, yielding computed tomography-like images compared with radiographs, yet with true weight-bearing, shorter acquisition time, and lower radiation. The aim of this study was to test two hypotheses: first, multiplanar weight-bearing imaging would localize deformity with respect to the talus in patients with posterior tibial dysfunction compared with controls, and second, multiplanar weight-bearing imaging would correlate with specific radiographic parameters of posterior tibial tendon dysfunction on weight-bearing radiographs.
Methods:
Weight-bearing radiographs and multiplanar modified sectional weight-bearing images of the foot and ankle were made for twenty-three patients with flexible posterior tibial tendon dysfunction. Ten patients with imaging for unrelated pathological conditions served as controls. Thirteen radiographic parameters on the transverse, sagittal, and coronal views of multiplanar weight-bearing imaging in the study group were evaluated and compared with those in the control group. The same parameters on standing weight-bearing radiographs of patients in the study group were compared with those in the control group.
Results:
Significant differences between study and control groups were found on multiplanar weight-bearing imaging for six of thirteen radiographic parameters (p < 0.05), notably the sagittal talonavicular angle as well as sagittal and transverse talar-first metatarsal angles (p = 0.027, p = 0.003, and p = 0.004, respectively). However, only one parameter on weight-bearing radiographs (lateral talar-first metatarsal angle) reached significance (p < 0.05). Correlation showed excellent, very good, and good agreement between both imaging modalities for three, two, and five parameters, respectively.
Conclusions:
Deformity with respect to the talus in posterior tibial tendon dysfunction is multifactorial, but was notably seen at the talonavicular joint in the sagittal plane with both modalities. Good to excellent agreement was found between weight-bearing radiographs and multiplanar weight-bearing images for many parameters; however, a greater number of significant differences was found between the flatfoot and control groups for multiplanar weight-bearing images. This implies a potential role for multiplanar modified sectional weight-bearing imaging as a more informative tool to assess posterior tibial tendon dysfunction in the physiological, full weight-bearing position.
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