Are orthoses useful for treating PTTD?
The tibia is posterior and is regarded as the most important dynamic stabilizing muscle of the medial longitudinal arch. Dysfunction is a common cause of foot pain. Posterior tendon dysfunction (PTTD) occurs when pronation is prolonged until the end of the stance phase of walking, which can lead to pain, gait disturbance, excessive mechanical stress, and medial longitudinal arch collapse.
A two-step classification tool for PTTD is the refined classification of PTTD by Bluman and Myerson.
Type I : tenderness along the posterior tibial tendon (+/- 5 degrees hindfoot valgus)
Type II : flexible hindfoot valgus, weakness of the lower extremities and foot dysfunction which are sub-classified can be:
IIA : Forefoot varus and possible PTT pain
IIB : Forefoot abduction
IIC : Fixed forefoot varus with medial columnar instability and Doris -Flexion of the first ray.
The treatment of PTTD often includes orthotics with the aim of stabilizing and supporting the medial longitudinal arch and controlling the valgus angulation of the rear foot. There is inconclusive evidence of the effectiveness of orthotic treatment for PTTD Type I or Type II, and this systematic review should be the first of its kind in answering that question.
method
This was a systematic review with 4 RCT studies in which 189 patients participated. The review was registered successfully and adhered to Prisma. There was a decent explanation of the review methods used for the items, as well as an analysis of the risk of bias. Obviously, the studies involved are not very extensive and due to their size there is an element of bias that must be taken into account when interpreting the results. It's also quite difficult to dazzle attendees for orthotics!
Clinical relevance
The aim of the systematic review was to answer the question of whether orthotic treatment is effective in treating functional disorders of the posterior tibial tendon in stages I and II.
Each review study used different types of exercise and different orthotics, so it is difficult to draw firm conclusions. The exercises ranged from gastroc stretching to progressive concentric or eccentric Tib-Post exercises to plantar flexion exercises on the ankle. Of all the exercises, the group that included concentric exercises plus orthotics showed the greatest improvement over 5 MWT and VAS. The only study that only used orthotics did not improve as much as all of the orthotic and exercise trials.
In all of the included studies, the importance of comfort and compatibility with shoes was particularly pointed out. After all, if the orthotics do not fit in the shoes or patient use is uncomfortable, they will not stick! Therefore, always consider a custom insole first and foremost.
PTTD is a risk factor for plantar fasciitis
Plantar heel pain is a very common disease of the musculoskeletal system and is often wrongly diagnosed as plantar fasciitis. The cause of plantar heel pain varies, and there are a number of risk factors that can contribute to overloading this area. To treat plantar heel pain, we need to consider the differential diagnosis and consider all the factors involved. In this course, you will learn from a skilled clinician the risk factors for plantar heel pain and how to implement effective evidence-based management.
Deep immersion in the treatment of heel pain
