Abstract
Introduction: Tibialis posterior tendon dysfunction is a common cause of foot pain and dysfunction in the middle aged patients. Initially, it presents as medial ankle pain and swelling, with or without a flexible flat foot, later progressing on to a fixed deformity. Operative management for the early stages of tendon dysfunction poses a significant workload on hospitals and physical burden on patients. We have evaluated non-operative management of early tibialis posterior tendon dysfunction (1).
Methods: This is a prospective study on patients with stage I and II tibialis posterior tendon dysfunction treated with a structured physiotherapy protocol. Twelve consecutive patients referred to a foot and ankle consultant with early tibialis posterior dysfunction from July 2008 were included in the study. The physiotherapy regime includes repetitive resisted active dorsiflexion, inversion, eversion, heel rise, and tip toe walking. The intensity of physiotherapy is progressively increased over the period of four months in four phases. Criteria for successful rehabilitation are ability to perform greater than ten single stance heel rises and tip toe walking for more than 100 yards. Patients who cannot achieve the expected progression were re-referred for surgical intervention. All the patients were referred for support with orthoses, however, only a few received the orthoses during the treatment period. The outcome was assessed using the validated outcome score Foot Function Index (FFI) before and after physiotherapy regimen.
Results: The study group consisted of 10 females and two males with 10 unilateral and two bilateral cases. The mean age was 59 years (48 to 79). The average number of physiotherapy visits was five. Prior to treatment the mean number of single stance tip toes performed by the patients was four. Out of 12 patients, ten successfully completed the rehabilitation. The mean FFI before rehabilitation was 55, which improved to 19 at the end of four months rehabilitation. On analysis using a paired t test 95% CI for mean difference: (25.07, 46.93) P < 0.0001. The improvement was consistent with all the three components of FFI (pain, activity and function) (p< 0.0001).
Conclusion: This study suggests early tibialis posterior tendon dysfunction can be treated effectively with structured physiotherapy.
Correspondence should be addressed to: Mr Andrew H. N. Robinson, Editorial Secretary, Department of Trauma and Orthopaedics, BOX 37, Addenbrooke’s Hospital, Cambridge CB2 2QQ, England.
Reference:
1 Alvarez RG, Marini A, Schmitt C, Saltzman CL. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int. 2006 Jan;27(1): 2–8 Google Scholar
