What's the gold-standard treatment of PosteriorTib tendon dysfunction?

Well, it seems there isn't one, but it also seems some therapies that might be beneficial are not being talked about!

A new study sheds some light on this.

Ross MH, Smith MD, Mellor R, et al
Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines
BMJ Open Sport & Exercise Medicine 2018;4:e000430. doi: 10.1136/bmjsem-2018-000430

Objective To systematically review all randomised clinical trials to determine the efficacy of local strengthening exercises compared with other forms of conservative management for adults with posterior tibial tendon dysfunction.
Design Systematic review.
Data sources Four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase and PubMed) were searched up to June 2018.
Eligibility criteria for selecting studies The study included randomised clinical trials investigating individuals with posterior tibial tendon dysfunction where local strengthening was compared with other forms of conservative management with respect to pain, function and/or physical impairment outcome measures. Standardised mean differences (SMDs) were used to compare change scores between groups and descriptors of exercise prescription assessed according to the Template for Intervention Description and Replication and the Toigo and Boutellier recommendations.
Results 3 studies (n=93) were eligible for inclusion in the review. Varying strengthening exercises were compared with stretching and foot orthoses (n=2) or no intervention (n=1). Moderate effects (SMD 0.6–1.2) were found for reducing pain and disability with eccentric strengthening in conjunction with stretching and orthoses compared with concentric exercises, stretching and orthoses combined, and stretching and orthoses alone. Evaluation of exercise prescription parameters demonstrated minimal reporting, with the only consistent parameters being the number of sets and repetitions of the exercises, and the duration of the experimental period.
Conclusion This review demonstrates the paucity of high-quality research for the conservative management of posterior tibial tendon dysfunction, and highlights the lack of exercise prescription parameters reported in clinical trials.

What is already known?

  • Posterior tibial tendon dysfunction is a progressive condition occurring along a continuum from tendon pain and dysfunction to acquired flatfoot deformity.
  • Management in the early stages is typically conservative, focusing on local strengthening exercises and arch-supporting devices.

What are the new findings?

  • High-quality clinical trials for the efficacy of exercise management in posterior tibial tendon dysfunction are lacking.
    Exercise prescription parameters are poorly reported in the literature.
  • Preliminary evidence suggests exercise is beneficial in reducing pain and disability.

There article may be read in its entirty here


Simon Bartold
Director of Bartold Clinical