Nonoperative management of posterior tibial tendon dysfunction

Area of Science:

• Orthopedics
• Biomechanics
• Rehabilitation Medicine

Background:

• Posterior tibial tendon dysfunction (PTTD) is a common cause of acquired flatfoot, particularly in middle-aged and elderly individuals.
• Nonoperative management is often the first line of treatment for PTTD, aiming to reduce pain and improve function.

Purpose of the Study:

• To evaluate the effectiveness of orthotic interventions for patients diagnosed with posterior tibial tendon dysfunction.
• To assess patient outcomes, including pain, function, and satisfaction, following treatment with orthoses.

Main Methods:

• A cohort of 49 patients with PTTD were treated with either molded ankle-foot orthoses (40 feet) or UC Biomechanics Laboratory shoe inserts with medial posting (13 feet).
• Patient outcomes were assessed using a functional scoring system evaluating pain, function, assistive device use, ambulation distance, and patient satisfaction.
• Follow-up averaged 20.3 months, with an average orthosis wear time of 14.9 months.

Main Results:

• Sixty-seven percent of patients achieved good to excellent results with orthotic treatment.
• The average age of patients was 66 years, with 37 women and 12 men.
• While 33% discontinued orthosis use due to discomfort or inconvenience, surgical intervention was reserved for those who failed conservative management or had poor tolerance.

Conclusions:

• Aggressive nonoperative management with orthoses, such as molded ankle-foot orthoses or UC Biomechanics Laboratory shoe inserts, is an effective treatment for PTTD.
• Orthotic treatment is particularly beneficial for elderly patients with sedentary lifestyles or those with medical comorbidities.
• Surgical intervention should be considered for patients who do not respond to an adequate trial of orthotic bracing.