Date of Award

2023

Document Type

Thesis

Department

Physical Therapy

First Advisor

Richard Morgan

Keywords

Posterior tibial tendon dysfunction (PTTD), foot trauma, bony involvement, deformity, foot, primal reflex release techniques (PRRT)

Abstract

Background and Purpose. Posterior tibial tendon dysfunction (PTTD) is a progressive and debilitating disease that can lead to bony involvement or deformity. Common symptoms of PTTD include medial ankle and foot pain and acquired flat foot deformity. The purpose of this case study is to examine physical therapy interventions in a patient with chronic PTTD.

Case Description. This case study describes the 15-week physical therapy management in an outpatient clinic for a 34-year-old female with unstaged PTTD presenting with pain, decreased range of motion, strength deficits and muscle imbalance, impaired balance, and impaired gait. The patient lived a very active lifestyle prior to treatment that had been negatively affected due to pathology.

Intervention. The physical therapy treatment included stretching, strengthening, proprioceptive training, cold laser, ASTYM, rigid taping techniques, bracing, primal reflex release techniques (PRRT), and diaphragmatic breathing.

Outcomes. Following physical therapy, the patient had improved strength and range of motion, as well as improved function with walking and fitness activities. The patient had an improved Focus on Therapeutic Outcomes (FOTO) score from 52/100 to 63/100. The patient did continue to have increased pain with prolonged standing, long-distance walking, and was not able to fully return to her prior level of function without pain. The patient was referred to podiatry due to a plateau in progress. The patient opted to pursue surgical intervention.

Discussion. The patient’s response to treatment and ultimate need for surgery was congruent with prognosis for Stage 2A PTTD and beyond. Future research is needed to determine the effect of specific interventions on each stage of PTTD

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