Advances in biomechanics of posterior tibial tendon dysfunction and flatfoot deformity

Introduction

The objective of this presentation is to highlight the clinical and laboratory-based research related to posterior tibial tendon dysfunction (PTTD).

Methods and results

• Defining the flatfoot: clinical, foot pressure, radiologic

• Critical evaluation of flatfoot deformity: in vitro

• How often does the flatfoot occur?

• Normal arch development

• Why is the flatfoot a problem?

• Why does the flatfoot occur?

• ○ 1. Effects of weightbearing [1]

• ○ 2. Lost of static support [2]

• ○ 3. Loss of dynamic support [3]

• ○ 4. Anatomic predisposition

• ○ 5. Joint subluxation

• Causes of flatfoot in adults

• ○ 1. Posterior tibial tendon dysfunction (PTTD)

• ○ 2. Arthritis: Midfoot, hindfoot, ankle

• ○ 3. Hypermobile flatfoot

• ○ 4. Neuropathic arthropathy

• ○ 5. Fracture malunion

• ○ 6. Inflammatory arthropathy

• ○ 7. Peroneal spastic flatfoot

• ○ 8. Neuromuscular disorder

• ○ 9. Other

• PTTD etiology

• PT muscle, tendon anatomy

• PT function

• PT muscle activity during gait

• Factors predisposing to PTTD

• ○ PT gliding resistance

• PT pathoanatomy

• Natural history of PTTD

• PTTD evaluation: symptoms, signs

• Investigative studies

• Gait analysis in PTTD patients

• Simulated walking: Normal, PTTD [4]

• PTTD treatment

• PTTD treatment results

• Failures, complications

Conclusion

• Current recommendations