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Tae-Ha Lim, Hyung Rae Cho, Keum Nae Kang, Chang Joon Rhyu, Sung Won Chon, Young Su Lim, Jee In Yoo, Jung-Won Kim, Young Uk Kim
RATIONALE: Ankle syndesmotic injuries occasionally require long-term therapy for recovery and can result in tendon injury. Posterior tibial tendon dysfunction (PTTD) is an acquired deformity that can cause flatfoot deformity. The current nonoperative management of PTTD includes nonsteroidal antiinflammatory drugs (NSAIDs), orthopedic devices. Although various treatment options have been attempted, optimal treatments for each stage of the condition are debated. Polydeoxyribonucleotide (PDRN) is effective in healing of chronic wounds associated with tissue damage by attracting tissue growth factors...
December 2016: Medicine (Baltimore)
Naoki Yoshioka, Kazuya Ikoma, Masamitsu Kido, Kan Imai, Masahiro Maki, Yuji Arai, Hiroyoshi Fujiwara, Daisaku Tokunaga, Nozomu Inoue, Toshikazu Kubo
BACKGROUND: The recent classifications for posterior tibial tendon dysfunction (PTTD) stage II are based on forefoot deformity, but there is still no consensus regarding a detailed explanation of the clinical condition. The purposes of this study were to clarify the clinical condition of flatfoot deformity using three-dimensional (3D) computed tomography (CT) imaging under loading on both healthy and flat feet and to compare 3D movement of the forefoot in response to load. METHODS: Ten volunteers and 10 PTTD stage II patients with symptomatic flatfoot deformity were examined...
March 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Christopher Neville, Mary Bucklin, Nathaniel Ordway, Frederick Lemley
STUDY DESIGN: Controlled laboratory, repeated measures. BACKGROUND: Posterior tibial tendon dysfunction is a common musculoskeletal problem that includes tendon degeneration and collapse of the medial arch of the foot (flatfoot deformity). Ankle-foot orthoses (AFOs) typically are used to correct flatfoot deformity. Correction of flatfoot deformity involves increasing forefoot adduction, forefoot plantar flexion, and hindfoot inversion. OBJECTIVES: To test whether a foot orthosis with a lateral extension reduces forefoot abduction in patients with stage II posterior tibial tendon dysfunction while walking...
January 2016: Journal of Orthopaedic and Sports Physical Therapy
M C Cöster, B E Rosengren, A Bremander, M K Karlsson
BACKGROUND: Patients with adult acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction (PTTD) may require surgery but few reports have evaluated the outcome. METHODS: We evaluated 21 patients with a median age of 60 (range 37-72) years who underwent different surgical reconstructions due to stage II AAFD before and 6 and 24 months after surgery by the validated Self-Reported Foot and Ankle Score (SEFAS), Short Form 36 (SF-36) and Euroquol 5 Dimensions (EQ-5D)...
December 2015: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Michael A Arnoldner, Michael Gruber, Stefanie Syré, Karl-Heinz Kristen, Hans-Jörg Trnka, Franz Kainberger, Gerd Bodner
PURPOSE: Posterior tibial tendon dysfunction is the most common cause of acquired asymmetric flatfoot deformity. The purpose of this study was to determine and compare the diagnostic value of MRI and high-resolution ultrasound (HR-US) in posterior tibial tendon dysfunction (PTTD), and assess their correlation with intraoperative findings. MATERIALS AND METHODS: We reviewed 23 posterior tibial tendons in 23 patients with clinical findings of PTTD (13 females, 10 males; mean age, 50 years) with 18MHz HR-US and 3T MRI...
September 2015: European Journal of Radiology
Kemal Erol, Ali Yavuz Karahan, Ülkü Kerimoğlu, Banu Ordahan, Levent Tekin, Muhammed Şahin, Ercan Kaydok
Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid...
January 28, 2015: Clinics and Practice
Jian Xu, Yijun Zhang, Hassan Muhammad, Xu Wang, Jiazhang Huang, Chao Zhang, Xiang Geng, Xin Ma
BACKGROUND: This study aims to evaluate the rotation and translation of each joint in the hindfoot and compare the differences in healthy foot with that in stage II PTTD flatfoot by analyzing the reconstructive three-dimensional (3D) computed tomography (CT) image data during several extreme positions. METHODS: CT scans of 20 healthy feet and 20 feet with stage II PTTD flatfoot were taken in maximal positions of plantarflexion, dorsiflexion, inversion, eversion, external rotation and internal rotation conditions...
May 2015: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Liang Gao, Justin S Yuan, Gregory J Heden, John A Szivek, Mihra S Taljanovic, L Daniel Latt, Russell S Witte
Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, they could be used to quantify the severity of tendonosis and help determine the appropriate treatment...
April 2015: IEEE Transactions on Bio-medical Engineering
M G Amila N Silva, Si Heng Sharon Tan, Hwei Chi Chong, Hsien Ching David Su, Inderjeet Rikhraj Singh
BACKGROUND: The prevalence of tibialis posterior tendon dysfunction (PTTD) is estimated to be as high as 3% to 4% in Western populations, and it is one of the most commonly misdiagnosed conditions of the foot and ankle. METHODS: Clinical and radiological outcomes were assessed in grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening. The clinical and radiological findings recorded were the SF-36 score on physical function and mental health, midfoot and hindfoot American Orthopaedic Foot and Ankle Society (AOFAS) clinical scores, the midfoot and visual analog pain scores, as well as the radiological measurements of the hindfoot calcaneal pitch, talo-first metatarsal angle, and medial cuneiform height...
February 2015: Foot & Ankle International
Kyle S Peterson, Christopher F Hyer
Adult acquired flatfoot deformity is a debilitating musculoskeletal condition affecting the lower extremity. Posterior tibial tendon dysfunction (PTTD) is the primary etiology for the development of a flatfoot deformity in an adult. PTTD is classified into 4 stages (with stage IV subdivided into stage IV-A and IV-B). This classification is described in detail in this article.
July 2014: Clinics in Podiatric Medicine and Surgery
Jeremy L Walters, Samuel S Mendicino
Classically, adult posterior tibial tendon dysfunction (PTTD) was considered primarily a tendon rupture and was treated as such with soft tissue repair alone. The understanding that PTTD involves more than simply an inflammatory condition or tendon rupture but also a muscle imbalance, leading to a flatfoot, osteoarthritis, and peritalar subluxation, led to surgeons advocating osseous procedures as well. The advancements in knowledge of the pathomechanics of the deformity have modified the role that soft tissue repair plays in surgical treatment, but the importance of soft tissue restoration in flatfoot repair should not be overlooked...
July 2014: Clinics in Podiatric Medicine and Surgery
Łukasz Kołodziej, Marek Napiontek, Arkadiusz Kazimierczak
BACKGROUND: Posterior tibial tendon dysfunction (PTTD) ranks among the most common causes of adult acquired flatfoot deformity. The deformity develops gradually through characteristic stages and its early manifestations are often ignored or mis-diagnosed. The aim of the study was to gain an insight into what the participants of the 5th Polish Foot and Ankle Society Congress knew about the diagnosis and treatment of flatfoot. MATERIAL AND METHODS: An anonymous survey described the clinical presentation of a hypothetical patient with fixed stage III (according to the Johnson and Strom classification) acquired flatfoot deformity in PTTD...
November 2013: Ortopedia, Traumatologia, Rehabilitacja
Jose Antônio Veiga Sanhudo, Joao Luiz Ellera Gomes
BACKGROUND: Leg length discrepancy (LLD) is associated with a variety of orthopaedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). PURPOSE: To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction...
April 2014: Foot & Ankle Specialist
Y Zhang, J Xu, X Wang, J Huang, C Zhang, L Chen, C Wang, X Ma
OBJECTIVE: The objective of this study was to evaluate the rotation and translation of each joint in the hindfoot and compare the load response in healthy feet with that in stage II posterior tibial tendon dysfunction (PTTD) flatfoot by analysing the reconstructive three-dimensional (3D) computed tomography (CT) image data during simulated weight-bearing. METHODS: CT scans of 15 healthy feet and 15 feet with stage II PTTD flatfoot were taken first in a non-weight-bearing condition, followed by a simulated full-body weight-bearing condition...
2013: Bone & Joint Research
Wenmin Chen, Peng Zhan, Erik De Clercq, Christophe Pannecouque, Jan Balzarini, Xin Jiang, Xinyong Liu
A series of N2,N4-disubstituted-1,1,3-trioxo-2H,4H-pyrrolo[1,2-b][1,2,4,6]thiatriazine derivatives (PTTDs) was designed and synthesized by a facile route. The biological assay results showed that five most potent compounds displayed inhibitory activity against HIV-1 at low micromolar concentrations (EC50=5.1-8.9 μM). Structure-activity relationship analysis indicated that N2-(3-halogenated-benzyl) analogues were more potent than N2-(unsubstituted-benzyl) analogues. The N4-substitutions contributed to the antiviral activity in the following order: 2-/3-cyano substituted benzyl > 2-/3-halogenated benzyl > non-substituted benzyl > 4-halogenated benzyl...
November 15, 2013: Bioorganic & Medicinal Chemistry
Nicholas J Vaudreuil, William R Ledoux, Grant C Roush, Eric C Whittaker, Bruce J Sangeorzan
Posterior tibialis tendon (PTT) dysfunction (PTTD) is associated with adult acquired flatfoot deformity. PTTD is commonly treated with a flexor digitorum longus (FDL) tendon transfer (FDLTT) to the navicular (NAV), medial cuneiform (CUN), or distal residuum of the degraded PTT (rPTT). We assessed the kinetic and kinematic outcomes of these three attachment sites using cadaveric gait simulation. Three transfer locations (NAV, CUN, rPTT) were tested on seven prepared flatfoot models using a robotic gait simulator (RGS)...
January 2014: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Reinhard Schuh, Florian Gruber, Axel Wanivenhaus, Nikolaus Hartig, Reinhard Windhager, Hans-Joerg Trnka
PURPOSE: Stage II posterior tibial tendon dysfunction (PTTD) can be treated by flexor digitorum longus (FDL) tendon transfer and medial displacement calcaneal osteotomy (MDCO). Numerous authors have studied the clinical and radiographic results of this procedure. However, little is known about the kinematic changes. Therefore, the purpose of this study was to assess plantar-pressure distribution in these patients. METHODS: Seventy-three patients with PTTD stage II underwent FDL tendon transfer and MDCO...
September 2013: International Orthopaedics
Siddhant K Mehta, R Bradley Kellum, George H Robertson, Allen Ryves Moore, Scott A Wingerter, Thom A Tarquinio
BACKGROUND: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD. METHODS: An institutional review board-approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet)...
October 2013: Foot & Ankle International
Jean Brilhault, Vincent Noël
BACKGROUND: The decision to offer surgery for Stage II posterior tibial tendon deficiency (PTTD) is a difficult one since orthotic treatment has been documented to be a viable alternative to surgery at this stage. Taking this into consideration we limited our treatment to bony realignment by a lengthening calcaneus Evans osteotomy and tendon balancing. The goal of the study was to clinically evaluate PTT functional recovery with this procedure. METHOD: The patient population included 17 feet in 13 patients...
October 2012: Foot & Ankle International
Nilgün Bek, Ibrahim Engin Simşek, Suat Erel, Yavuz Yakut, Fatma Uygur
OBJECTIVE: The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD). METHODS: The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56 ± 17.59) group or center-based rehabilitation (28 cases; mean age: 28...
2012: Acta Orthopaedica et Traumatologica Turcica
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