Diagnostic validity of clinical tests for posterior tibialis tendon dysfunction.

August 9, 2006

June 3, 2010

Aldo Russell de Boer, Senior Musculoskeletal Physiotherapist (Imperial College Healthcare NHS Trust)

Noelene Davey, Imperial College Healthcare NHS Trust

In [Posterior Tibialis Tendon Dysfunction] are [clinical tests and questions] diagnostically valid compared to [MRI/Surgery]?

A 50 year old female patient presents to the physiotherapy department for assessment of medial ankle and foot pain that came on insidiously 6 months ago. She has been diagnosed with posterior tibialis tendon dysfunction (PTTD) by an orthopaedic consultant, but the patient would like to know what the accuracy/validity of the clinical diagnosis is without also having an MRI scan.

Medline 1966-09 using the Pubmed Clinical Queries database was searched up to December 2009 using the following terms ... (Posterior[All Fields] AND Tibialis[All Fields] AND ("tendons"[MeSH Terms] OR "tendons"[All Fields] OR "tendon"[All Fields])) AND Diagnosis/Broad[filter]. In addition bibliographies were screened for relevant papers. Finally, BestBETS database was searched using familiar terms.

Pub Med: http: //www.ncbi.nlm.nih.gov/sites/pubmedutils/clinical
Best BETS: http://www.bestbets.org

After duplicates had been removed, 120 abstracts were identified as being possibly relevant from the combined searches. 14 papers were identified that potentially answered the three part search question and the full articles were retrieved. No papers were of sufficient quality, and therefore no evidence to be used to answer the PICO question proposed.

Despite many papers reporting that posterior tibialis tendon dysfunction is a diagnosis made by clinical history and examination, there is no high quality evidence to support this. This, in part, is due to a lack of large clinical studies, but also perhaps more importantly an ongoing lack of awareness of the condition in the general medical and allied health community. The current body of evidence does report common clinical presentations, but none have rigorously assessed these against a suitable gold standard of MRI or surgery in a robust clinical trial setting.

There is currently only weak evidence to support history, clinical tests or clinical variables in the diagnosis of posterior tibial tendon dysfunction. Local guidelines should be sought for guidance, and if there are none in place local guidelines should be developed by a specialist MDT team.

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