University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA; Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France.
University of Iowa, Carver College of Medicine, Department of Orthopedics and Rehabilitation, Iowa City, IA, USA; Federal University of Sao Paulo, Paulista School of Medicine, Department of Orthopedics and Traumatology, Sao Paulo, SP, Brazil.
Foot Ankle Surg. 2022 Oct;28(7):995-1001. doi: 10.1016/j.fas.2022.02.004. Epub 2022 Feb 12.
Posterior Tibial Tendon (PTT) dysfunction is considered to have an important role in Progressive Collapsing Foot Deformity (PCFD). The objective of our study was to assess the relationship between PTT status and three-dimensional foot deformity in PCFD.
Records from 25 patients with PCFD were included for analysis. The PTT was considered deficient in patients with a positive single heel rise test or a deficit in inversion strength. Three-dimensional foot deformity was assessed using the Foot and Ankle Offset (FAO) from Weight-Bearing-CT imaging. Hindfoot valgus, midfoot abduction and medial longitudinal arch collapse were assessed on X-Rays using hindfoot moment arm, talonavicular coverage angle and Meary's angle respectively. Deland and Rosenberg MRI classifications were used to classify PTT degeneration.
PCFD with PTT deficit (13/25) had a mean FAO of 7.75 + /- 3.8% whereas PCFD without PTT deficit had a mean FAO of 6.68 + /- 3.9% (p = 0.49). No significant difference was found between these groups on the hindfoot moment arm and the talonavicular coverage angle (respectively p = 0.54 and 0.32), whereas the Meary's angle was significantly higher in case of PCFD with PTT deficit (p = 0.037). No significant association was found between PTT degeneration on MRI and FAO.
PCFD associated three-dimensional deformity, hindfoot valgus and midfoot abduction were not associated with PTT dysfunction. PTT dysfunction was only associated with a worse medial longitudinal arch collapse in our study. Considering our results, it does not appear that PTT is the main contributor to PCFD.
Level III, Retrospective Comparative Study.
胫骨后肌腱（PTT）功能障碍被认为在进行性塌陷足畸形（PCFD）中起重要作用。我们研究的目的是评估 PTT 状态与 PCFD 三维足畸形之间的关系。
纳入 25 例 PCFD 患者进行分析。在单足跟抬高试验阳性或内翻力量不足的患者中，PTT 被认为是不足的。使用负重 CT 成像的足踝偏移（FAO）评估三维足畸形。在 X 光片上，使用后足矩臂、距舟覆盖角和 Meary 角分别评估后足外翻、中足外展和内侧纵弓塌陷。Deland 和 Rosenberg MRI 分类用于分类 PTT 退变。
PTT 缺陷的 PCFD（13/25）的 FAO 平均值为 7.75±3.8%，而 PTT 无缺陷的 PCFD 的 FAO 平均值为 6.68±3.9%（p=0.49）。这些组之间在后足矩臂和距舟覆盖角上没有发现显著差异（分别为 p=0.54 和 0.32），而在 PTT 缺陷的 PCFD 中，Meary 角明显更高（p=0.037）。MRI 上的 PTT 退变与 FAO 之间没有显著关联。
PCFD 相关的三维畸形、后足外翻和中足外展与 PTT 功能障碍无关。在我们的研究中，PTT 功能障碍仅与更严重的内侧纵弓塌陷相关。考虑到我们的结果，PTT 似乎不是 PCFD 的主要原因。
III 级，回顾性比较研究。
