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Post-Tibial Tendon Dysfunction
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Post-Tibial Tendon Dysfunction - April 11, 2008 10:33:44 PM
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mgiard3
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I have been diagnosed with Post-Tibial Tendon Dysfunction and Pes Planus. I have gotten special made orthotics for my feet which makes them feel better throughtout the day. I also used to have shin splints asscocited with the tendon dysfunction, but that has gone away due to PT treatment. The only problem I seem to have is that my calf muscles (where the gastrocnemious meets the achilles tendon) tighten very quickly when I jog and I have no clue why (even within 5 mins). Any suggestions maybe why? Could the orthotic be a problem? I can run through the tightness, but it will never go away. I stretch everyday and seems not to help. Any help would be greatly appreciated. I am lost.
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RE: Post-Tibial Tendon Dysfunction - April 23, 2008 9:05:43 PM
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RoosaPT
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There are specific manual therapy stretches and subtalar joint mobilization techniques that could help correct the dysfunction. I suggest finding a manual therapy certified physical therapist. The cause could also be originating from your hip. Was this ruled out? and what specific techniques were used to correct the tibialis posterior problem?
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RE: Post-Tibial Tendon Dysfunction - June 1, 2008 2:12:14 PM
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cwagon
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Never met a flat foot that the hip couldn't fix. May take a long time, but without addressing the lumbar spine and hip stiffness, the orthotic will be a lousy band-aid.
We are seeing symptoms worsen like yours with orthotics as the imbalances are working even harder to put the foot into valgus. This isn't always the case, but the posterior tibial tendonitis is a compensation for a deficiency in countering gravity's tendencies. The screening process should reveal where to start (t/s, l/s, hips).
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RE: Post-Tibial Tendon Dysfunction - June 1, 2008 4:41:05 PM
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Tom Reeves DPT ATC
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I have. I don't think you can say that the hip is the dominant factor here. The structure of the foot defines the interface with the ground. If the structure of the foot is suboptimal, the hip can help but cannot correct completely without developing overuse of its own.
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RE: Post-Tibial Tendon Dysfunction - June 1, 2008 8:03:28 PM
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Sebastian Asselbergs
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Tom , I agree. We cannot simply ignore that there are occasional congenital anatomical issues or developmental, overuse or traumatic changes that cause trouble with the lower extremity.
However, with the above patient, I am tempted to say: start looking for something higher up. Since the gastrocs seem to be resistant to stretching, one must assume (IF the stretches are properly done) that the muscles are triggered to be tightening in protection of something....and that something may be the sural nerve, which can cause pain in the tib post tendon area.... Yep, I think some neurodynamic testing may be helpful. Sural nerve, sciatic nerve etc .
Just some thoughts.
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RE: Post-Tibial Tendon Dysfunction - June 1, 2008 8:07:50 PM
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cwagon
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Totally disagree, Tom. Perhaps it is semantics, so I will rephrase and suggest I've never met a functional flat foot that the hips couldn't fix. If you take the individual in the open chain and manually give them an arch, there is absolutely no reason why that arch can't be maintained in the closed chain by means other than the foot.
Of course if there is a structural issue to the foot itself, I would agree that all biomechanical bets are off, and there should be some other mode of correction.
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RE: Post-Tibial Tendon Dysfunction - June 1, 2008 9:32:49 PM
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TexasOrtho
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The missing link might be your running mechanics. The position of the LE during initial contact through stance while running or jogging can make a difference. I have found anecdotally that the longer my fairly mobile foot stays in stance (i.e. slower pace) the more risk I have for developing heel pain, lateral knee or hip pain.
My faster paced runs for 5K and 10K's tend to be much less painful for my legs from an orthopedic standpoint. Again, my rationale is that the intrinsic characteristics of the kinematic chain haven't changed, but the demands have. It's something you might want to consider.
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RE: Post-Tibial Tendon Dysfunction - June 2, 2008 7:55:39 AM
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Tom Reeves DPT ATC
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With that, I have no arguement. There is a world of difference between someone with a structurally flat foot and one that is simply floppy. But, in my opinion, the PT needs to address proprioception at the foot, knee, and hip in all planes to adequately control it.
Bas,
If the gastroc are not responsive to stretching, the provocateur might just be a destructive foot type requiring medial posting. OR they could need a bunch of butt exercises, feet on the ground of course, Or both.
We tend to be an either/or profession and human bodies just don't work that way.
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RE: Post-Tibial Tendon Dysfunction - June 2, 2008 8:05:16 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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Tom, I have no argument with that. That's what I meant with "occasional congenital anatomical issues or developmental, overuse or traumatic changes".
Assuming that those things were eliminated from evaluation and/or by treatment, I would move to neural issues.
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