title: Ankle and foot kinematics associated with stage II PTTD during stance.
abstract: BACKGROUND
  Subjects with stage II posterior tibial tendon dysfunction (PTTD) exhibit abnormal foot kinematics; however, how individual segment kinematics (hindfoot (HF) or first metatarsal (first MET) segments) influence global foot kinematics is unclear. The purpose of this study was to compare foot and ankle kinematics and sagittal plane HF and first MET segment kinematics between stage II PTTD and controls.
  
  
  METHODS
  Thirty patients with stage II PTTD and 15 healthy controls were evaluated. Kinematic data from the tibia, calcaneus, and first MET were collected during walking using three dimensional motion analysis techniques. A three-segment foot model (HF, calcaneus; first MET, first metatarsal, and tibia) was used to calculate relative angles (ankle, HF relative to tibia; midfoot, first MET relative to HF) and segment angles (HF and first MET relative to the global). A mixed effect ANOVA model was utilized to compare angles between groups for each variable.
  
  
  RESULTS
  Patients with PTTD showed greater ankle plantarflexion (p = 0.02) by 6.8 degrees to 8.4 degrees prior to or at 74% of stance; greater HF eversion (p < 0.01) across stance (mean difference = 4.5 degrees); and greater first MET dorsiflexion (p < 0.01) across stance (mean difference = 8.8 degrees). HF and first MET segment angles revealed greater HF dorsiflexion (p = 0.01) during early stance and greater first MET dorsiflexion (p = 0.001) across stance.
  
  
  CONCLUSIONS
  Abnormal HF and first MET segment kinematics separately influence both ankle and midfoot movement during walking in subjects with stage II PTTD.
  
  
  CONCLUSIONS
  These abnormal kinematics may serve as another measure of response to clinical treatment and/or guide for clinical strategies (exercise, orthotics, and surgery) seeking to improve foot kinematics.
authors.affiliation: Ithaca College-Rochester, Physical Therapy, 1100 South Goodman, Rochester, NY 14620, USA. jhouck@ithaca.edu
authors.forename: Jeff R
authors.initials: JR
authors.lastname: Houck
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Neville
authors.forename: Josh
authors.initials: J
authors.lastname: Tome
authors.forename: Adolph S
authors.initials: AS
authors.lastname: Flemister
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D003430:Cross-Sectional Studies; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008684:Metatarsus / Q000503:physiopathology; D008875:Middle Aged; D037081:Posterior Tibial Tendon Dysfunction / Q000503:physiopathology*