Bracing and Strengthening for Posterior Tibial Tendon Dysfunction
Condition: Posterior Tibial Tendon Dysfunction
MeSH terms: Posterior Tibial Tendon Dysfunction
Study type: Interventional
Phase: Phase 2

Summary: 
      Posterior tibial tendon dysfunction (PTTD) is a problem with the tendon connecting one of the
      lower leg muscles to the foot bone. PTTD can cause pain, swelling, and a flattened foot and
      may require surgery if left untreated. Normal treatment for PTTD includes physical therapy
      exercise. In treating similar conditions in the lower leg, exercises that are active, like
      strengthening, seem to have better results than exercises that are passive, like stretching.
      This study will determine whether adding strengthening exercises to a normal PTTD treatment
      that includes wearing a brace and stretching is more beneficial than just wearing a brace and
      stretching.
    

Detailed description: 
      Posterior tibial tendon dysfunction (PTTD) involves inflammation, overstretching, or both of
      the posterial tibial tendon, which connects the tibialis posterior muscle to the bones in the
      foot. PTTD can cause pain in the inner ankle and development of a flat foot. Without
      treatment, correction of PTTD may require surgery. Standard interventions that may prevent
      the need for surgery include orthotic devices, bracing, and physical therapy, among other
      possibilities. Within physical therapy, foot exercises can be either active-as in the case of
      strengthening exercises-or passive-as in the case of stretching exercises. Evidence from
      clinical treatment of similar conditions suggests that active exercises are more effective
      than passive exercises in leading to recovery. This study will determine whether adding
      strengthening exercises to a normal intervention of bracing and stretching is more effective
      in improving a range of symptoms in stage II PTTD patients than using only bracing and
      stretching exercises.

      Participants with Stage II PTTD will be recruited and placed in one of two groups for the
      duration of the 12-week study. The first group will undergo regular bracing and perform
      stretching exercises. The second group will undergo regular bracing and perform stretching
      and strengthening exercises. Braces, worn during weight-bearing tasks throughout the study,
      will include ankle stirrup support and medial longitudinal arch support. Strengthening
      exercises, which will be preceded by a warm-up of the posterior tibialis muscle, will include
      bilateral heel raises, foot adduction and rear foot inversion with thera-tubing, and
      unilateral heel raises. Frequency of exercise and number of repetitions will increase over
      the course of the study until participants are performing 3 sets of 30 repetitions 2 times
      per day. Assessments, which will occur at study entry, after 6 weeks, and after 12 weeks,
      will include foot range of motion, length of the posterior tibial muscle, and
      self-assessments of function.
    

Intervention name(s): Bracing; Strengthening exercises; Stretching exercises
Intervention type(s): Device; Other; Other
Intervention description(s): Participants will wear a brace that includes ankle stirrup support and medial longitudinal arch support. The brace will be worn during weight-bearing tasks throughout the 12-week study.; Participants performed strengthening exercises progressively longer each time for up to 3 sets of 30 repetitions twice daily by the third visit. Exercises included bilateral heel raises, foot adduction/rear foot inversion with thera-tubing, and unilateral heel raises. Participants increased resistance by using thera-bands with higher levels of resistance over the 12 week period. The amount of resistance was progressed according to patient tolerance at each visit. Strengthening exercises were preceded by the control stretching exercises which constituted a "warm up."; Subjects were provided with written descriptions and pictures demonstrating 2 range-of-motion exercises which included a wall calf stretch, and a supine ankle active range-of-motion exercise. Subjects were instructed to perform 3 sets of the stretching exercises, 2 times a day, similar to the intervention group. Each stretching exercise was performed twice and held for 30 seconds.
Other intervention name(s): Air Lift Brace
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: PTTD; Tendinopathy; Tendon Injuries; Muscular Diseases; Foot Diseases