Abstract
Background and purpose: Posterior tibialis tendon dysfunction is the leading cause of flat foot deformity among older adults. Prior research investigating conservative treatment focused on inactive older adults with immobilization, surgery, and activity reduction as the treatment options. This case report describes conservative physical therapy intervention for a young female runner incorporating active rest, hip and ankle strengthening, manual therapy of the posterior tibialis and running specific gait training in treating stage two PTTD. Case Description: The patient was a female cross-country runner with pain on the posterior lower left ankle and calf. Her primary complaint was an inability to compete in practice and 5km cross-country races distance due to pain immediately after the onset of running. Pertinent initial examination findings included: pain rated 5/10 during running and a 0/10 at rest, manual muscle test (MMT) weakness in left ankle inversion and plantarflexion rated 4/5, hip abduction and extension MMT rated 4/5, and pain upon palpation up to a 4/10 along the posterior tibialis tendon and muscle belly. The patient was seen in outpatient physical therapy for a total of seven visits over the course of four weeks. Physical therapy intervention included therapeutic exercise, soft tissue mobilization, and patient education. Outcomes: At discharge from physical therapy, key examination findings included: pain rating of 0/10 with running, ankle inversion and plantarflexion MMT strength of 4+/5, hip extension and abduction MMT of 4+/5, and outcome measure reporting on the Lower Extremity Functional Scale (LEFS) from a 64/80 to 78/80. Discussion: Following four weeks of conservative physical therapy intervention for treatment of stage two posterior tibialis tendon dysfunction, the patient was able to return to full participation in cross country practice and competitions.