Catherine Patla1, Janice Lwin2, Laura Smith3, Eric Chaconas1. 1. University of St. Augustine for Health Sciences, St. Augustine, FL, USA. 2. Kellaya Performance, San Diego, CA, USA. 3. University of Michigan-Flint, Flint, MI, USA.
Abstract
BACKGROUND AND PURPOSE: Posterior tibialis tendinopathy is a prevalent musculoskeletal condition often resulting in gait abnormalities along with medial ankle and foot pain. The purpose of this case report is to describe the treatment of a patient with a three year history of posterior tibialis tendinopathy utilizing a combination of cuboid manipulation and exercise. CASE DESCRIPTION: The patient was a 23-year old female recreational runner and collegiate basketball player reporting a three year history of chronic left ankle and lower leg pain. Outcome measures included the numeric pain rating scale, lower extremity functional scale, strength, passive joint mobility, and functional activities including running distance. Standard care for the treatment of tendinopathy was followed for six weeks with minimal functional improvements. Clinical reasoning skills were applied to redirect the hypothesis implicating limitations in cuboid-calcaneus internal rotation joint mobility contributing to a posterior tibialis tendinopathy. Manipulation at this joint was utilized to restore mobility. This intervention resulted in an immediate reduction in symptoms and improved functioning. Both muscle strengthening and functional task training were implemented post manipulation. OUTCOMES: At discharge, the patient reported full recovery and no pain with running 14 miles. Her lower extremity functional score improved to 78/80, posterior tibialis strength increased to 4/5 and the patient was able to perform 12 single leg heel raises without pain. DISCUSSION: By restoring cuboid internal rotation mobility, associated midtarsal pronation, and lower extremity neuromuscular control, the posterior tibialis muscle was able to perform efficiently, thus resolving the chronic tendinopathy and returning the patient to optimum functional ability of running. LEVEL OF EVIDENCE: 4.
BACKGROUND AND PURPOSE: Posterior tibialis tendinopathy is a prevalent musculoskeletal condition often resulting in gait abnormalities along with medial ankle and foot pain. The purpose of this case report is to describe the treatment of a patient with a three year history of posterior tibialis tendinopathy utilizing a combination of cuboid manipulation and exercise. CASE DESCRIPTION: The patient was a 23-year old female recreational runner and collegiate basketball player reporting a three year history of chronic left ankle and lower leg pain. Outcome measures included the numeric pain rating scale, lower extremity functional scale, strength, passive joint mobility, and functional activities including running distance. Standard care for the treatment of tendinopathy was followed for six weeks with minimal functional improvements. Clinical reasoning skills were applied to redirect the hypothesis implicating limitations in cuboid-calcaneus internal rotation joint mobility contributing to a posterior tibialis tendinopathy. Manipulation at this joint was utilized to restore mobility. This intervention resulted in an immediate reduction in symptoms and improved functioning. Both muscle strengthening and functional task training were implemented post manipulation. OUTCOMES: At discharge, the patient reported full recovery and no pain with running 14 miles. Her lower extremity functional score improved to 78/80, posterior tibialis strength increased to 4/5 and the patient was able to perform 12 single leg heel raises without pain. DISCUSSION: By restoring cuboid internal rotation mobility, associated midtarsal pronation, and lower extremity neuromuscular control, the posterior tibialis muscle was able to perform efficiently, thus resolving the chronic tendinopathy and returning the patient to optimum functional ability of running. LEVEL OF EVIDENCE: 4.
Authors: Kornelia Kulig; Stephen F Reischl; Amy B Pomrantz; Judith M Burnfield; Susan Mais-Requejo; David B Thordarson; Ronald W Smith Journal: Phys Ther Date: 2008-11-20