BraceLab Clinical Clues

October 2020 No. 18

How Can an AFO Possibly Help Posterior Tibial Tendon Dysfunction?

Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

Posterior Tibial Tendon

Recently a podiatrist requested a sample of the Push Ankle Foot Orthosis (AFO) for a patient with posterior tibial tendon dysfunction (PTTD) (1). Before sending the sample, we explained this brace is designed for patients with foot drop. The podiatrist understood this, but after studying the Push AFO design, he thought it could benefit his patients with PTTD.

Typically patients with posterior tibial tendon dysfunction initially wear a walking boot for 6-8 weeks to allow the tendon to rest and to decrease swelling. If pain is controlled after six weeks, the patient switches to wearing an orthotic shoe insert inside their normal shoe. The orthotic shoe insert decreases the tendon workload by supporting the patient’s medial arch and allows a return to normal footwear.

The podiatrist noted that some patients have increased pain when they shift from wearing the walking boot to the orthotic shoe insert because of the sudden change of tendon loading. He was searching for a more successful way to transition his patients out of the walking boot.

Descending stairs in the Push AFO

We were curious whether this worked! The podiatrist stated the Push AFO has two unique features that benefit his patients with PTTD. The first is the ability to wear the brace with an orthotic shoe insert either under or over the AFO’s flexible footplate. The second desirable feature is the oblique adjustable dorsiflexion assistance straps. He feels the straps’ unique angle supports the medial arch of the foot in the same manner as the posterior tibial tendon during the stance phase of the gait cycle (2-3).

This podiatrist altered his protocol for treating PTTD to include use of the Push AFO with an orthotic shoe insert for four weeks after the initial 6 to 8 weeks in a walking boot. During these four weeks, patients are instructed to decrease the tension of the dorsiflexion assistance straps weekly. If pain is controlled, the AFO is discontinued at four weeks and the patient continues using the orthotic shoe insert.

Thinking outside the box allowed this clinician to provide a better solution for his patients with posterior tibial tendon dysfunction. Based on this experience with the Push AFO, BraceLab now recommends this product for others with this diagnosis.

 

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. Physical Therapy. 2009;89(1):26-37.

2. Basmajian J, Stecko G. The role of muscles in support of the arch of the foot. J Bone Joint Surg Am. 1963;45:1184–1190.

3. Otis JC, Gage T. Function of the posterior tibial tendon muscle. Foot Ankle Clin. 2001;6(1):1-v. doi:10.1016/s1083-7515(03)00071-8.

 

Download Clinical Clues No.18, How Can an AFO Possibly Help Posterior Tibial Tendon Dysfunction?; October 2020

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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