TP Insufficiency (from Google Sheet)

What role does the Tibialis Posterior play during gait?

It is a dynamic stabilizer that locks the midtarsal joint and everts the hindfoot to create a rigid lever.

How does the Tibialis Posterior control pronation?

It eccentrically controls pronation.

What is the primary cause of acquired/adult flat foot?

Tibialis Posterior Insufficiency.

What are the likely results of Tibialis Posterior Insufficiency?

Osseous, soft tissue, and vascular failures, along with intratendinous shear from multiple insertion points.

What are the characteristics of Tibialis Posterior Insufficiency?

Tissue degeneration, neovascularization, increased number of fibroblasts, and tendon thickening.

What are some exam findings for Tibialis Posterior Insufficiency?

Foot posture, palpation with tenderness, loss of dorsiflexion, MMT of Tib Post weakness, heel rise test, poor single leg balance, abnormal gait, and progressive flattening of the arch.

What does the heel rise test indicate in patients with Tibialis Posterior Insufficiency?

It specifically indicates at least stage 1.

What are the stages of Tibialis Posterior Insufficiency?

Stage I: Pain, tenderness to palpation, edema; Stage II: Flexible deformity/incompetent tendon (IIa: Rearfoot valgus, IIb: Rearfoot valgus & midfoot abduction); Stage III: Fixed deformity; Stage IV: Early ankle degenerative changes.

What are intrinsic risk factors for Tibialis Posterior Insufficiency?

Age over 50 years, female sex, bony factors (pes planus, anteversion), ligamentous laxity, and vascular abnormalities (HTN, DM).

What are extrinsic risk factors for Tibialis Posterior Insufficiency?

Sedentary lifestyle, occupations with prolonged standing, and inappropriate footwear.

What key history should be noted in patients with Tibialis Posterior Insufficiency?

Pain in the region of the tibialis posterior, progressive flattening of the arch, and difficulty with gait.

What is the mainstay of treatment for Tibialis Posterior Insufficiency?

Footwear adjustments.

What treatments are recommended for acute/severe Tibialis Posterior Insufficiency?

Use of a CAM walker for 2-6 weeks.

What interventions are suggested for strengthening in Tibialis Posterior Insufficiency?

Strengthening the tibialis posterior, intrinsics, gastroc/soleus, and hip.

Why should fibularis muscles not be strengthened in Tibialis Posterior Insufficiency?

Strengthening fibularis muscles promotes eversion, which is the motion being controlled in TPI.

What are the outcomes for patients with Stage I/II Tibialis Posterior Insufficiency?

Approximately 90% are managed successfully conservatively within 4 months.

What surgical options are available for more advanced cases of Tibialis Posterior Insufficiency?

Flexor hallucis longus surgery, calcaneal osteotomy, arthrodesis, etc.

What percentage of the adult population is affected by Tibialis Posterior Insufficiency?

About 3%.

What additional condition might patients with Tibialis Posterior Insufficiency experience?

Lateral ankle impingement.

What strengthening exercises can help prevent hip/knee collapse in Tibialis Posterior Insufficiency?

Strengthening hip abductors, external rotators, and hip extensors.

Stage I

- P!, TTP, edema (like a strain)

Stage II

- Flexible deformity/incompetent tendon

Stage IIa

-Rearfoot valgus (calcaneus)

Stage IIb

Rearfoot valgus & midfoot abd (pulls forefoot wide)

Stage III

- Fixed deformity

Stage IV

- Early ankle degenerative changes