Changes in gait associated with acute stage II posterior tibial tendon dysfunction

Area of Science:

• Biomechanics
• Orthopedics
• Sports Medicine

Background:

• Posterior Tibialis Tendon Dysfunction (PTTD) is a common cause of adult acquired flatfoot.
• Understanding gait alterations in acute PTTD is crucial for effective treatment.
• Previous research has not fully elucidated the complex kinematic and muscle activation patterns in early-stage PTTD.

Purpose of the Study:

• To investigate and compare gait mechanics in patients with acute stage II PTTD versus healthy controls.
• To analyze hindfoot and midfoot kinematics, plantar pressures, and muscle electromyography (EMG) in PTTD patients.

Main Methods:

• Gait analysis including hindfoot/midfoot kinematics and kinetics.
• Plantar foot pressure mapping and Center of Pressure Excursion Index (CPEI) calculation.
• Electromyographic (EMG) assessment of posterior tibialis, gastrocnemius, anterior tibialis, and peroneal muscles.

Main Results:

• Significant differences in gait mechanics were observed between PTTD patients and healthy volunteers.
• PTTD patients exhibited limited hindfoot eversion and increased midfoot external rotation during specific gait phases.
• EMG data indicated compensatory activation in antagonist and synergistic muscles, including peroneals, anterior tibialis, and gastrocnemius.

Conclusions:

• Clinical observations of altered gait in PTTD are biomechanically confirmed.
• Posterior tibialis tendon dysfunction involves widespread muscle compensation.
• Non-operative PTTD treatment should target not only the posterior tibialis but also compensatory muscle groups.