Bracing and Strengthening for Posterior Tibial Tendon Dysfunction
Condition: Posterior Tibial Tendon Dysfunction
MeSH terms: Posterior Tibial Tendon Dysfunction
Intervention: Bracing; Strengthening exercises; Stretching exercises
Intervention description: 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.
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 39.0
Sex: All
Minimum age: 40 Years
Maximum age: 80 Years
Healthy volunteers: No
Keywords: PTTD; Tendinopathy; Tendon Injuries; Muscular Diseases; Foot Diseases

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.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Diagnosis of Stage II PTTD disorder

          -  Flexible flat foot deformity

          -  Palpable tenderness of posterior tibial tendon

          -  Swelling of the posterior tibial tendon sheath

          -  Pain during single limb heel rise

          -  Abnormal rear foot valgus

          -  Abnormal fore foot abduction as compared to contralateral side

        Exclusion Criteria:

          -  Unable to walk for more than 15 meters

          -  Comorbidity within the foot

          -  Loss of protective sensation of the foot, as indicated by Semmes-Weinstein
             monofilament test of 5.07

          -  Inflammatory arthropathies

          -  Score greater than 23 on Mini Mental Status exam

          -  Arch index of less than 0.255

          -  Inability to assume a subtalar neutral posture

          -  PTTD in both feet