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Nonsurgical Management of Posterior Tibial Tendon Dysfunction With Orthoses and Resistive Exercise: A Randomized Controlled Trial

K Kulig, PT, PhD, is Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP-155, Los Angeles, CA 90033 (USA).
SF Reischl, PT, DPT, OCS, is Adjunct Associate Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California.
AB Pomrantz, PT, DPT, OCS, ATC, is Adjunct Instructor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California.
JM Burnfield, PT, PhD, is Director, Movement Sciences Center, and Clifton Chair in Physical Therapy and Movement Science, Institute for Rehabilitation Science and Engineering, Madonna Rehabilitation Hospital, Lincoln, Nebraska.
S Mais-Requejo, PT, DPT, OCS, is Adjunct Assistant Professor of Clinical Physical Therapy, Division of Biokinesiology and Physical Therapy, University of Southern California.
DB Thordarson, MD, is Professor of Orthopedic Surgery, Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
RW Smith, MD, is Orthopedic Foot and Ankle Surgeon, Long Beach Memorial Medical Center, Long Beach, California.

kulig{at}usc.edu

Background and Purpose: Tibialis posterior tendinopathy can lead to debilitating dysfunction. This study examined the effectiveness of orthoses and resistance exercise in the early management of tibialis posterior tendinopathy.

Subjects: Thirty-six adults with stage I or II tibialis posterior tendinopathy participated in this study.

Methods: Participants were randomly assigned to 1 of 3 groups to complete a 12-week program of: (1) orthosis wear and stretching (O group); (2) orthosis wear, stretching, and concentric progressive resistive exercise (OC group); or (3) orthosis wear, stretching, and eccentric progressive resistive exercise (OE group). Preintervention and postintervention data (Foot Functional Index, distance traveled in the 5-Minute Walk Test, and pain immediately after the 5-Minute Walk Test) were collected.

Results: Foot Functional Index scores (total, pain, and disability) decreased in all groups after the intervention. The OE group demonstrated the most improvement in each subcategory, and the O group demonstrated the least improvement. Pain immediately after the 5-Minute Walk Test was significantly reduced across all groups after the intervention.

Discussion and Conclusion: People with early stages of tibialis posterior tendinopathy benefited from a program of orthosis wear and stretching. Eccentric and concentric progressive resistive exercises further reduced pain and improved perceptions of function.

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