Posterior tibial tendon dysfunction: Current concepts including operative and nonoperative approaches

Current Opinion in Orthopaedics

Volumn 15, Issue 2, 2004, Pages 62-68

  Lawrence, Steven J ^a   Wright, Raymond D ^a  

^a UNIVERSITY OF KENTUCKY   (United States)

Author keywords

Dorsolateral peritalar subluxation; Posterior tibial tendon; Spring ligament

Indexed keywords

ANTIINFLAMMATORY AGENT;

BIOMECHANICS; DISEASE COURSE; FLATFOOT; HUMAN; IMMOBILIZATION; LIGAMENT; PATHOGENESIS; PLASTER CAST; POSTERIOR TIBIAL TENDON DYSFUNCTION; PRIORITY JOURNAL; REVIEW; SOFT TISSUE; SUBLUXATION; TISSUE DEGENERATION;

EID: 1642302750     PISSN: 10419918     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001433-200404000-00004     Document Type: Review

References (39)

1. Goldner JL, Keats PK, Bassett FH III, et al.: Progressive talipes equinovalgus due to trauma or degeneration of the posterior tibial tendon and medial plantar ligaments. Orthop Clin North Am 1974, 5:39-50.
2. Johnson KA, Strom DE: Posterior tibial tendon dysfunction. Clin Orthop 1989, 239:196-206.
3. Myerson MS: Adult acquired flatfoot deformity: treatment of dysfunction of the posterior tibial tendon. J Bone Joint Surg Am 1996, 78:780-792.
4. Sarrafian SK: Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional, 2nd ed. Philadelphia: JB Lippincott; 1993.
5. Davis WH, Sobel M, DiCarlo EF, et al.: Gross, histological, and microvascular anatomy and biomechanical testing of the spring ligament complex. Foot Ankle Int 1996, 17:95-102.
6. Petersen W, Hohmann G, Pufe T, et al.: Structure of the human tibialis posterior tendon. Arch Orthop Trauma Surg (e-pub April 2003). A study of the gliding zone of the PTT by light microscopy, transmission electron microscopy, and immunohistochemical methods. The poor repair response of fibrocartilage may be a critical factor in the pathogenesis of PTT dysfunction.
7. Benjamin M, Ralphs JR: Fibrocartilage in tendons and ligaments-an adaption to compressive load. J Anat 1998, 193:481-494.
8. Toolan, BC, Sangeorzan BJ, Hansen ST Jr: Complex reconstruction for the treatment of dorsolateral peritalar subluxation of the foot. J Bone Joint Surg Am 1999, 81:1545-1560.
9. Wacker J, Calder JDF, Engstrom CM, et al.: MR morphometry of posterior tibialis muscle in the adult acquired flat foot. Foot Ankle Int 2003, 24:354-357. An interesting MRI study of the muscles of 12 patients before surgery for painful PTT dysfunction. All patients with complete PTT rupture demonstrated fatty infiltration of the atrophic posterior tibial muscle and increased volume of the FDL muscle. In contrast, the muscle belly of the dysfunctional but intact musculotendinous unit demonstrated atrophy but no fatty infiltration.
10. Mosier SM, Lucas DR, Pomeroy G, et al.: Pathology of the posterior tibial tendon in posterior tibial tendon dysfunction. Foot Ankle Int 1998, 19:520-524.
11. Petersen W, Hohmann G, Stein V, et al.: The blood supply of the posterior tibial tendon. J Bone Joint Surg Br 2002, 84:141-144. A study of the vascular density of three separate 1-cm segments of the PTT measured by a gamma well counter after injection with radioisotope demonstrated hypovascularity in the retromalleolar tendon.
12. Frey C, Shereff M, Greenidge N: Vascularity of the posterior tibial tendon. J Bone Joint Surg Am 1990, 72:884-888.
13. Goncalves-Neto J, Witzel SS, Teodoro WR, et al.: Changes in collagen matrix composition in human posterior tibial tendon dysfunction. Joint Bone Spine 2002, 69:189-194. This study details the structural organization and molecular changes in the ultrastructure of the degenerated PTT tendon.
14. Kanatli U, Yetkin H, Yalcin N: The relationship between accessory navicular and medial longitudinal arch: evaluation with a plantar pressure distribution measurement system. Foot Ankle Int 2003, 24:486-489. This is a retrospective study of 92 patients with an accessory navicular. The longitudinal arch was assessed with an "arch index" in these individuals. The presence of an accessory navicular was not statistically associated with pes planus deformity.
15. Mizel MS, Temple HT, Scranton PE, et al.: Role of the peroneal tendons in the production of the deformed foot with posterior tibial tendon deficiency. Foot Ankle Int 1999, 20:285-289.
16. Basmajian JV, Stecko G: The role of muscles in arch support of the foot. J Bone Joint Surg Am 1963, 45:1184-1190.
17. Sutherland DH: An electromyographic study of the plantar flexors of the ankle in normal walking on the level. J Bone Joint Surg Am 1966, 48:66-71.
18. Vertullo CJ, Nunley JA: Acquired flatfoot deformity following posterior tibial tendon transfer for peroneal nerve injury. J Bone Joint Surg Am 2002, 84:1214-1217.
19. Thordarson DB, Schmotzer H, Chon J, et al.: Dynamic support of the human longitudinal arch. A biomechanical evaluation. Clin Orthop 1995, 316:165-172.
20. Crary JL, Hollis JM, Manoli A II: The effect of plantar fascia release on strain in the spring and long plantar ligaments. Foot Ankle Int 2003, 24:245-250. This is an in vitro study of the contributions of static constraints to the support of the human arch. Increased strain in the spring and long plantar ligaments was noted when an axial load was applied after section of the plantar fascia.
21. Gazdag AR, Cracchiolo A III: Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair. J Bone Joint Surg Am 1997, 79:675-681.
22. Baravarian B, Zgonis T, Lowery C: Use of the Cobb procedure in the treatment of posterior tibial tendon dysfunction. Clin Podiatr Med Surg 2002, 19:371-389.
23. Choi K, Lee S, Otis JC: Anatomical reconstruction of the spring ligament using peroneus longus tendon graft. Foot Ankle Int 2003, 24:430-436. This is an in vitro study of three forms of tendon reconstruction using the peroneus longus tendon to reconstruct the spring ligamentous complex. This procedure may be combined with other reconstructive procedures to address acquired flatfoot deformities.
24. Stephens HM, Walling AK, Solmen JD, et al.: Subtalar repositional arthrodesis for adult acquired flatfoot. Clin Orthop 1999, 365:69-73.
25. Stagni R, Learndini A, O'Connor JJ, et al. Role of passive structures in the mobility and stability of the human subtalar joint: a literature review. Foot Ankle Int 2003, 24:402-409. This is a review of the anatomy and the biomechanics of the subtalar joint. This joint complex continues to be poorly understood. Recent studies appear to refute the mitered hinge concept of subtalar mechanics.
26. Wapner KL, Chao W: Nonoperative treatment of posterior tibial tendon dysfunction. Clin Orthop 1999, 365:39-45.
27. Chao W, Wapner KL, Lee TH, et al.: Nonoperative treatment of posterior tibial tendon dysfunction. Foot Ankle Int 1996, 17:736-741.
28. Crates JM, Richardson EG: Treatment of stage I posterior tibial tendon dysfunction with medial soft tissue procedures. Clin Orthop 1999, 365:46-49.
29. Harper MC: Talonavicular arthrodesis for the acquired flatfoot in the adult. Clin Orthop 1999, 365:65-68.
30. Thomas RL, Wells BC, Garrison RL, et al.: Preliminary results comparing two methods of lateral column lengthening. Foot Ankle Int 2001, 22:107-119.
31. Fayazi AH, Nguyen H-V, Juliano PJ: Intermediate term follow-up of calcaneal osteotomy and flexor digitorum longus transfer for treatment of posterior tibial tendon dysfunction. Foot Ankle Int 2002, 23:1107-1111. This is a retrospective study of 23 patients with stage II dysfunction treated with calcaneal osteotomy and FDL transfer. The series reports good relief of pain and functional improvements of 96% at an average of 35-month follow-up and an average postoperative improvement of 39 point in the American Orthopaedic Foot and Ankle Society score.
32. Wacker JT, Hennessey MS, Saxby TS: Calcaneal osteotomy and transfer of the tendon of flexor digitorum longus for stage-II dysfunction of the tibialis posterior. Three to five year results. J Bone Joint Surg Br 2002, 84:54-58. This paper reports on the favorable outcomes of 51 patients after osteotomy and FDL tendon transfer at an average 51-month follow-up. However, the authors report an inconsistent restoration of the arch morphology with this technique.
33. Chi TD, Toolan BC, Sangeorzan BJ, et al.: The lateral column lengthening and medial column stabilization procedures. Clin Orthop 1999, 365:81-90.
34. Conti SF, Wong YS: Osteolysis of structural autograft after calcaneocuboid distraction arthrodesis for stage II posterior tibial tendon dysfunction. Foot Ankle Int 2002, 23:521-529. This retrospective study details an alarming rate of nonunion/osteolysis of tricorticate iliac crest bone grafts used for lateral column lengthening procedures.
35. Hyer CF, Lee T, Block AJ, et al.: Evaluation of the anterior and middle talocalcaneal articular facets and the Evans osteotomy. J Foot Ankle Surg 2002, 41:389-393. This is an interesting anatomic study involving the anterior and middle facets of the talocalcaneal articulations of 768 specimens; 56% of the specimens were found to have a conjoined facet. The facet interspace, when present, was 11.5-15 mm from the calcaneocuboid joint.
36. Fortin PT, Walling AK: Triple arthrodesis. Clin Orthop 1999, 365:91-99.
37. Romash MM: Triple arthrodesis for treatment of painful flatfoot, grade III posterior tibial tendon dysfunction. Tech Foot Ankle Surg 2003, 2:109-121. A concise review of the operative management of stage III PTT dysfunction by repositional triple arthrodesis. The article details the extensive preoperative assessment and step-by-step surgical technique necessary for this demanding procedure.
38. Kelley IP, Easley ME: Treatment of stage 3 acquired flatfoot. Foot Ankle Clin 2001, 6:153-166.
39. Kelley IP, Nunley JA: Treatment of stage 4 adult acquired flatfoot. Foot Ankle Clin 2001, 6:167-178.