Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies.
Tibialis posterior has a vital role during gait as the primary dynamic stabiliser of the medial longitudinal arch; however, the muscle and tendon are prone to dysfunction with several conditions. We present an overview of tibialis posterior muscle and tendon anatomy with images from cadaveric work on fresh frozen limbs and a review of current evidence that define normal and abnormal tibialis posterior muscle activation during gait. A video is available that demonstrates ultrasound guided intra-muscular insertion techniques for tibialis posterior electromyography.Current electromyography literature indicates tibialis posterior intensity and timing during walking is variable in healthy adults and has a disease-specific activation profile among different pathologies. Flat-arched foot posture and tibialis posterior tendon dysfunction are associated with greater tibialis posterior muscle activity during stance phase, compared to normal or healthy participants, respectively. Cerebral palsy is associated with four potentially abnormal profiles during the entire gait cycle; however it is unclear how these profiles are defined as these studies lack control groups that characterise electromyographic activity from developmentally normal children. Intervention studies show antipronation taping to significantly decrease tibialis posterior muscle activation during walking compared to barefoot, although this research is based on only four participants. However, other interventions such as foot orthoses and footwear do not appear to systematically effect muscle activation during walking or running, respectively. This review highlights deficits in current evidence and provides suggestions for the future research agenda.
Semple
Ruth
R
Division of Podiatric Medicine and Surgery, School of Health, Glasgow Caledonian University, Glasgow, UK. ruth.semple@gcal.ac.uk.
Murley
George S
GS
Woodburn
James
J
Turner
Deborah E
DE
Anat Rec. 1968 May;161(1):1-15
5664082
BMJ. 2004 Dec 4;329(7478):1328-33
15576744
J Bone Joint Surg Am. 1963 Sep;45:1184-90
14077983
J Anat. 1995 Dec;187 ( Pt 3):625-33
8586561
Clin Orthop Relat Res. 1989 Feb;(239):196-206
2912622
J Bone Joint Surg Am. 1977 Jun;59(4):531-7
863949
Foot Ankle Int. 2001 Jan;22(1):51-5
11206823
Arch Orthop Trauma Surg. 2004 May;124(4):237-42
12695917
Foot Ankle. 1989 Apr;9(5):219-25
2731833
J Electromyogr Kinesiol. 2009 Apr;19(2):e69-77
18053742
Am J Sports Med. 1993 Nov-Dec;21(6):805-10; discussion 810
8291630
Foot Ankle Int. 2006 Sep;27(9):723-7
17038285
Rheumatology (Oxford). 2002 Dec;41(12):1406-12
12468821
Gait Posture. 2009 Feb;29(2):172-87
18922696
Gait Posture. 2008 Feb;27(2):331-9
17583511
J Bone Joint Surg Am. 1990 Jul;72(6):884-8
2195033
Arch Phys Med Rehabil. 2008 Sep;89(9):1816-8
18760169
Clin Biomech (Bristol, Avon). 1999 Jan;14(1):14-23
10619086
Instr Course Lect. 1997;46:393-405
9143981
Med Sci Sports Exerc. 2008 Apr;40(4):593-600
18317390
Curr Opin Rheumatol. 1992 Apr;4(2):233-40
1581152
J Bone Joint Surg Am. 1986 Jan;68(1):95-102
3941124
Foot Ankle. 1991 Feb;11(4):244-7
1855713
J Bone Joint Surg Am. 1999 Aug;81(8):1173-82
10466651
Clin Orthop Relat Res. 1999 Aug;(365):12-22
10627682
J Bone Joint Surg Am. 2006 Aug;88(8):1764-8
16882899
Dev Med Child Neurol. 1984 Feb;26(1):88-93
6698330
Foot Ankle. 1982 May;2(6):318-24
7095673
Gait Posture. 2007 Apr;25(4):555-64
16876415
J Bone Joint Surg Br. 2002 Jan;84(1):141-4
11837820
Br J Rheumatol. 1995 Jul;34(7):645-6
7670784
J Bone Joint Surg Am. 1966 Jan;48(1):66-71
5902799
J Bone Joint Surg Am. 1983 Jul;65(6):748-54
6863356
Acta Orthop Scand Suppl. 1978;172:1-196
279212
Foot Ankle Int. 2004 Feb;25(2):85-95
14992708
J Orthop Sports Phys Ther. 2000 Feb;30(2):68-77
10693084
J Rheumatol. 2005 Feb;32(2):268-74
15693086
Musculoskeletal Care. 2003 Mar;1(1):21-33
20217661
J Bone Joint Surg Am. 1991 Feb;73(2):237-47
1993719
Am J Phys Med Rehabil. 1990 Jun;69(3):126-7
2163649
J Bone Joint Surg Am. 1959 Mar;41-A(2):189-208
13630955
J Electromyogr Kinesiol. 2006 Oct;16(5):522-30
16275015
Foot Ankle. 1992 Feb;13(2):70-9
1349292
J Pediatr Orthop. 2006 Nov-Dec;26(6):777-80
17065945
Foot Ankle Int. 1994 Jul;15(7):386-95
7951975
Dev Med Child Neurol. 1988 Apr;30(2):227-31
3384202
Foot Ankle Int. 1995 Mar;16(3):156-61
7599734
Foot Ankle Int. 2003 Oct;24(10):780-3
14587993
Arch Phys Med Rehabil. 1988 Feb;69(2):115-7
3341889
J Anat. 1964 Jul;98:437-53
14193201
Arthritis Rheum. 1988 Mar;31(3):441-6
3282520