Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines

Megan H Ross, Michelle D Smith, Rebecca Mellor, Bill Vicenzino, Megan H Ross, Michelle D Smith, Rebecca Mellor, Bill Vicenzino

Abstract

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.

Trial registration number: CRD42017076156.

Keywords: exercise; foot; physiotherapy; randomised controlled trial; tendinopathy.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart for selected trials included for the systematic review.
Figure 2
Figure 2
SMD (95% CI) for outcomes at 6 weeks. 5MWT, 5 min walk test; AOFAS, American Orthopaedic Foot and Ankle Society; BW, body weight; deg, degree; FFI, Foot Function Index; N/kg, Newtons per kilogram; ROM, range of motion; SMD, standardised mean difference; SMFA, Short Musculoskeletal Function Assessment; VAS, Visual Analogue Scale.
Figure 3
Figure 3
SMD (95% CI) for outcomes at 12 weeks. 5MWT, 5 min walk test; FFI, Foot Function Index; SMD, standardised mean differences; SMFA, Short Musculoskeletal Function Assessment; VAS, Visual Analogue Scale.

References

    1. Kohls-Gatzoulis J, Woods B, Angel JC, et al. . The prevalence of symptomatic posterior tibialis tendon dysfunction in women over the age of 40 in England. Foot Ankle Surg 2009;15:75–81. 10.1016/j.fas.2008.08.003
    1. Kulig K, Popovich JM, Noceti-Dewit LM, et al. . Women with posterior tibial tendon dysfunction have diminished ankle and hip muscle performance. J Orthop Sports Phys Ther 2011;41:687–94. 10.2519/jospt.2011.3427
    1. Chimenti RL, Tome J, Hillin CD, et al. . Adult-acquired flatfoot deformity and age-related differences in foot and ankle kinematics during the single-limb heel-rise test. J Orthop Sports Phys Ther 2014;44:283–90. 10.2519/jospt.2014.4939
    1. Neville C, Flemister A, Tome J, et al. . Comparison of changes in posterior tibialis muscle length between subjects with posterior tibial tendon dysfunction and healthy controls during walking. J Orthop Sports Phys Ther 2007;37:661–9. 10.2519/jospt.2007.2539
    1. Holmes GB, Mann RA. Possible epidemiological factors associated with rupture of the posterior tibial tendon. Foot Ankle 1992;13:70–9. 10.1177/107110079201300204
    1. Rosenberg ZS, Jahss MH, Noto AM, et al. . Rupture of the posterior tibial tendon: CT and surgical findings. Radiology 1988;167:489–93. 10.1148/radiology.167.2.3357960
    1. Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 1989;239:196–206. 10.1097/00003086-198902000-00022
    1. Kohls-Gatzoulis J, Angel J, Singh D. Tibialis posterior dysfunction as a cause of flatfeet in elderly patients. Foot 2004;14:207–9. 10.1016/j.foot.2004.06.003
    1. Lombardi CM, Dennis LN, Connolly FG, et al. . Talonavicular joint arthrodesis and evans calcaneal osteotomy for treatment of posterior tibial tendon dysfunction. J Foot Ankle Surg 1999;38:116–22. 10.1016/S1067-2516(99)80022-2
    1. Myerson MS, Corrigan J, Thompson F, et al. . Tendon transfer combined with calcaneal osteotomy for treatment of posterior tibial tendon insufficiency: a radiological investigation. Foot Ankle Int 1995;16:712–8. 10.1177/107110079501601108
    1. Mehta SK, Kellum RB, Robertson GH, et al. . Radiographic correction of stage III posterior tibial tendon dysfunction with a modified triple arthrodesis. Foot Ankle Int 2013;34:1355–63. 10.1177/1071100713489285
    1. Conti MS, Chan JY, Do HT, et al. . Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity. Foot Ankle Int 2015;36:239–47. 10.1177/1071100714564217
    1. Conti MS, Ellis SJ, Chan JY, et al. . Optimal position of the heel following reconstruction of the stage II adult-acquired flatfoot deformity. Foot Ankle Int 2015;36:919–27. 10.1177/1071100715576918
    1. Soukup DS, MacMahon A, Burket JC, et al. . Effect of obesity on clinical and radiographic outcomes following reconstruction of stage II adult acquired flatfoot deformity. Foot Ankle Int 2016;37:245–54. 10.1177/1071100715614841
    1. Zhu Y, Xu XY. Treatment of stage II adult acquired flatfoot deformity with subtalar arthroereises. Foot Ankle Spec 2015;8:194–202. 10.1177/1938640014548320
    1. Teasdall RD, Johnson KA. Surgical treatment of stage I posterior tibial tendon dysfunction. Foot Ankle Int 1994;15:646–8. 10.1177/107110079401501203
    1. Crates JM, Richardson EG. Treatment of stage I posterior tibial tendon dysfunction with medial soft tissue procedures. Clin Orthop Relat Res 1999;365:46–9. 10.1097/00003086-199908000-00006
    1. Sharma P, Singh SK, Rao SG. Is there a role for surgical decompression in stage I tibialis posterior tendon dysfunction? Foot 2003;13:1–4. 10.1016/S0958-2592(02)00074-3
    1. Kulig K, Lederhaus ES, Reischl S, et al. . Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot Ankle Int 2009;30:877–85. 10.3113/FAI.2009.0877
    1. Alvarez RG, Marini A, Schmitt C, et al. . Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int 2006;27:2–8. 10.1177/107110070602700102
    1. Augustin JF, Lin SS, Berberian WS, et al. . Nonoperative treatment of adult acquired flat foot with the Arizona brace. Foot Ankle Clin 2003;8:491–502. 10.1016/S1083-7515(03)00036-6
    1. Garber CE, Blissmer B, Deschenes MR, et al. . Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 2011;43:1334–59. 10.1249/MSS.0b013e318213fefb
    1. Moher D, Liberati A, Tetzlaff J, et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535 10.1136/bmj.b2535
    1. Higgins PTJ, Green S. Cochrane handbook for systematic reviews of interventions. West Sussex: Sons Ltd, 2008.
    1. Ross MH, Smith MD, Vicenzino B. Reported selection criteria for adult acquired flatfoot deformity and posterior tibial tendon dysfunction: are they one and the same? A systematic review. PLoS One 2017;12:e0187201 10.1371/journal.pone.0187201
    1. Hoffmann TC, Glasziou PP, Boutron I, et al. . Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1687 10.1136/bmj.g1687
    1. Toigo M, Boutellier U. New fundamental resistance exercise determinants of molecular and cellular muscle adaptations. Eur J Appl Physiol 2006;97:643–63. 10.1007/s00421-006-0238-1
    1. Holden S, Rathleff MS, Jensen MB, et al. . How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review. Br J Sports Med 2018;52:385 10.1136/bjsports-2017-097547
    1. Hopkins WG. 2007. A new view of statistics. Internet society for sport science. .
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74. 10.2307/2529310
    1. Jeong TH, JK O, Lee HJ. The effect of the combined stretching and strengthening exercise on the clinical symptoms in posterior tibial tendon dysfunction patient. J Korean Foot Ankle Soc 2008;12:47–54.
    1. Houck J, Neville C, Tome J, et al. . Randomized controlled trial comparing orthosis augmented by either stretching or stretching and strengthening for stage II tibialis posterior tendon dysfunction. Foot Ankle Int 2015;36:1006–16. 10.1177/1071100715579906
    1. Kulig K, Reischl SF, Pomrantz AB, et al. . Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial. Phys Ther 2009;89:26–37. 10.2522/ptj.20070242
    1. Hunt KJ, Hurwit D. Use of patient-reported outcome measures in foot and ankle research. J Bone Joint Surg Am 2013;95:e118–1. 10.2106/JBJS.L.01476
    1. Cook JL, Docking SI. “Rehabilitation will increase the ‘capacity’ of your …insert musculoskeletal tissue here….” Defining ‘tissue capacity’: a core concept for clinicians. Br J Sports Med 2015;49:1484–5. 10.1136/bjsports-2015-094849
    1. Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol 2010;6:262–8. 10.1038/nrrheum.2010.43
    1. Cook JL, Rio E, Purdam CR, et al. . Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med 2016;50:1187–91. 10.1136/bjsports-2015-095422
    1. Kingma JJ, de Knikker R, Wittink HM, et al. . Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2007;41:e3 10.1136/bjsm.2006.030916
    1. Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med 2009;19:54–64. 10.1097/JSM.0b013e31818ef090
    1. Malliaras P, Maffulli N, Garau G. Eccentric training programmes in the management of lateral elbow tendinopathy. Disabil Rehabil 2008;30(20-22):1590–6. 10.1080/09638280701786195
    1. Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper’’s knee): a critical review of exercise programmes. Br J Sports Med 2007;41:217–23. 10.1136/bjsm.2006.032417
    1. Young MA, Cook JL, Purdam CR, et al. . Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. Br J Sports Med 2005;39:102–5. 10.1136/bjsm.2003.010587
    1. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 2001;9:42–7. 10.1007/s001670000148
    1. Silbernagel KG, Thomeé R, Thomeé P, et al. . Eccentric overload training for patients with chronic Achilles tendon pain–a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports 2001;11:197–206. 10.1034/j.1600-0838.2001.110402.x
    1. Mellor R, Bennell K, Grimaldi A, et al. . Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ 2018;361:k1662 10.1136/bmj.k1662
    1. Malliaras P, Barton CJ, Reeves ND, et al. . Achilles and patellar tendinopathy loading programmes. Sports Med 2013;43:267–86. 10.1007/s40279-013-0019-z
    1. American College of Sports Medicine. ACSM’’s exercise testing and prescription. Philadelphia: Lippincott Williams & Wilkins, 2017.
    1. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409–16. 10.1136/bjsm.2008.051193
    1. Soslowsky LJ, Thomopoulos S, Esmail A, et al. . Rotator cuff tendinosis in an animal model: role of extrinsic and overuse factors. Ann Biomed Eng 2002;30:1057–63. 10.1114/1.1509765
    1. Cook JL, Purdam CR. The challenge of managing tendinopathy in competing athletes. Br J Sports Med 2014;48:506–9. 10.1136/bjsports-2012-092078
    1. Cook JL, Purdam CR. Rehabilitation of lower limb tendinopathies. Clin Sports Med 2003;22:777–89. 10.1016/S0278-5919(03)00007-3
    1. Khan K, Cook J. The painful nonruptured tendon: clinical aspects. Clin Sports Med 2003;22:711–25. 10.1016/S0278-5919(03)00035-8
    1. Kountouris A, Cook J. Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheumatol 2007;21:295–316. 10.1016/j.berh.2006.12.003
    1. Silbernagel KG, Thomeé R, Eriksson BI, et al. . Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Br J Sports Med 2007;41:276–80. 10.1136/bjsm.2006.033464
    1. Knutzen KM, Price A. Lower extremity static and dynamic relationships with rearfoot motion in gait. J Am Podiatr Med Assoc 1994;84:171–80. 10.7547/87507315-84-4-171
    1. Koshino Y, Yamanaka M, Ezawa Y, et al. . Coupling motion between rearfoot and hip and knee joints during walking and single-leg landing. J Electromyogr Kinesiol 2017;37:75–83. 10.1016/j.jelekin.2017.09.004
    1. Souza TR, Pinto RZ, Trede RG, et al. . Temporal couplings between rearfoot-shank complex and hip joint during walking. Clin Biomech 2010;25:745–8. 10.1016/j.clinbiomech.2010.04.012
    1. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. J Orthop Sports Phys Ther 1987;9:160–5. 10.2519/jospt.1987.9.4.160
    1. Tiberio D. Pathomechanics of structural foot deformities. Phys Ther 1988;68:1840–9. 10.1093/ptj/68.12.1840
    1. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 2003;33:639–46. 10.2519/jospt.2003.33.11.639
    1. Dierks TA, Manal KT, Hamill J, et al. . Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther 2008;38:448–56. 10.2519/jospt.2008.2490
    1. Barwick A, Smith J, Chuter V. The relationship between foot motion and lumbopelvic-hip function: a review of the literature. Foot 2012;22:224–31. 10.1016/j.foot.2012.03.006
    1. Cashman GE. The effect of weak hip abductors or external rotators on knee valgus kinematics in healthy subjects: a systematic review. J Sport Rehabil 2012;21:273–84. 10.1123/jsr.21.3.273
    1. Nawoczenski DA, Saltzman CL, Cook TM. The effect of foot structure on the three-dimensional kinematic coupling behavior of the leg and rear foot. Phys Ther 1998;78:404–16. 10.1093/ptj/78.4.404
    1. Houck JR, Neville CG, Tome J, et al. . Ankle and foot kinematics associated with stage II PTTD during stance. Foot Ankle Int 2009;30:530–9. 10.3113/FAI.2009.0530
    1. Neville C, Flemister AS, Houck JR. Deep posterior compartment strength and foot kinematics in subjects with stage II posterior tibial tendon dysfunction. Foot Ankle Int 2010;31:320–8. 10.3113/FAI.2010.0320
    1. Rabbito M, Pohl MB, Humble N, et al. . Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction. J Orthop Sports Phys Ther 2011;41:776–84. 10.2519/jospt.2011.3545
    1. Tome J, Nawoczenski DA, Flemister A, et al. . Comparison of foot kinematics between subjects with posterior tibialis tendon dysfunction and healthy controls. J Orthop Sports Phys Ther 2006;36:635–44. 10.2519/jospt.2006.2293
    1. Ness ME, Long J, Marks R, et al. . Foot and ankle kinematics in patients with posterior tibial tendon dysfunction. Gait Posture 2008;27:331–9. 10.1016/j.gaitpost.2007.04.014

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