title: Tibialis posterior in health and disease: a review of structure and function with specific reference to electromyographic studies.
abstract: 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.
authors.affiliation: Division of Podiatric Medicine and Surgery, School of Health, Glasgow Caledonian University, Glasgow, UK. ruth.semple@gcal.ac.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Semple
authors.forename: George S
authors.initials: GS
authors.lastname: Murley
authors.forename: James
authors.initials: J
authors.lastname: Woodburn
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Turner
references.citation: Anat Rec. 1968 May;161(1):1-15
references.pmid: 5664082
references.citation: BMJ. 2004 Dec 4;329(7478):1328-33
references.pmid: 15576744
references.citation: J Bone Joint Surg Am. 1963 Sep;45:1184-90
references.pmid: 14077983
references.citation: J Anat. 1995 Dec;187 ( Pt 3):625-33
references.pmid: 8586561
references.citation: Clin Orthop Relat Res. 1989 Feb;(239):196-206
references.pmid: 2912622
references.citation: J Bone Joint Surg Am. 1977 Jun;59(4):531-7
references.pmid: 863949
references.citation: Foot Ankle Int. 2001 Jan;22(1):51-5
references.pmid: 11206823
references.citation: Arch Orthop Trauma Surg. 2004 May;124(4):237-42
references.pmid: 12695917
references.citation: Foot Ankle. 1989 Apr;9(5):219-25
references.pmid: 2731833
references.citation: J Electromyogr Kinesiol. 2009 Apr;19(2):e69-77
references.pmid: 18053742
references.citation: Am J Sports Med. 1993 Nov-Dec;21(6):805-10; discussion 810
references.pmid: 8291630
references.citation: Foot Ankle Int. 2006 Sep;27(9):723-7
references.pmid: 17038285
references.citation: Rheumatology (Oxford). 2002 Dec;41(12):1406-12
references.pmid: 12468821
references.citation: Gait Posture. 2009 Feb;29(2):172-87
references.pmid: 18922696
references.citation: Gait Posture. 2008 Feb;27(2):331-9
references.pmid: 17583511
references.citation: J Bone Joint Surg Am. 1990 Jul;72(6):884-8
references.pmid: 2195033
references.citation: Arch Phys Med Rehabil. 2008 Sep;89(9):1816-8
references.pmid: 18760169
references.citation: Clin Biomech (Bristol, Avon). 1999 Jan;14(1):14-23
references.pmid: 10619086
references.citation: Instr Course Lect. 1997;46:393-405
references.pmid: 9143981
references.citation: Med Sci Sports Exerc. 2008 Apr;40(4):593-600
references.pmid: 18317390
references.citation: Curr Opin Rheumatol. 1992 Apr;4(2):233-40
references.pmid: 1581152
references.citation: J Bone Joint Surg Am. 1986 Jan;68(1):95-102
references.pmid: 3941124
references.citation: Foot Ankle. 1991 Feb;11(4):244-7
references.pmid: 1855713
references.citation: J Bone Joint Surg Am. 1999 Aug;81(8):1173-82
references.pmid: 10466651
references.citation: Clin Orthop Relat Res. 1999 Aug;(365):12-22
references.pmid: 10627682
references.citation: J Bone Joint Surg Am. 2006 Aug;88(8):1764-8
references.pmid: 16882899
references.citation: Dev Med Child Neurol. 1984 Feb;26(1):88-93
references.pmid: 6698330
references.citation: Foot Ankle. 1982 May;2(6):318-24
references.pmid: 7095673
references.citation: Gait Posture. 2007 Apr;25(4):555-64
references.pmid: 16876415
references.citation: J Bone Joint Surg Br. 2002 Jan;84(1):141-4
references.pmid: 11837820
references.citation: Br J Rheumatol. 1995 Jul;34(7):645-6
references.pmid: 7670784
references.citation: J Bone Joint Surg Am. 1966 Jan;48(1):66-71
references.pmid: 5902799
references.citation: J Bone Joint Surg Am. 1983 Jul;65(6):748-54
references.pmid: 6863356
references.citation: Acta Orthop Scand Suppl. 1978;172:1-196
references.pmid: 279212
references.citation: Foot Ankle Int. 2004 Feb;25(2):85-95
references.pmid: 14992708
references.citation: J Orthop Sports Phys Ther. 2000 Feb;30(2):68-77
references.pmid: 10693084
references.citation: J Rheumatol. 2005 Feb;32(2):268-74
references.pmid: 15693086
references.citation: Musculoskeletal Care. 2003 Mar;1(1):21-33
references.pmid: 20217661
references.citation: J Bone Joint Surg Am. 1991 Feb;73(2):237-47
references.pmid: 1993719
references.citation: Am J Phys Med Rehabil. 1990 Jun;69(3):126-7
references.pmid: 2163649
references.citation: J Bone Joint Surg Am. 1959 Mar;41-A(2):189-208
references.pmid: 13630955
references.citation: J Electromyogr Kinesiol. 2006 Oct;16(5):522-30
references.pmid: 16275015
references.citation: Foot Ankle. 1992 Feb;13(2):70-9
references.pmid: 1349292
references.citation: J Pediatr Orthop. 2006 Nov-Dec;26(6):777-80
references.pmid: 17065945
references.citation: Foot Ankle Int. 1994 Jul;15(7):386-95
references.pmid: 7951975
references.citation: Dev Med Child Neurol. 1988 Apr;30(2):227-31
references.pmid: 3384202
references.citation: Foot Ankle Int. 1995 Mar;16(3):156-61
references.pmid: 7599734
references.citation: Foot Ankle Int. 2003 Oct;24(10):780-3
references.pmid: 14587993
references.citation: Arch Phys Med Rehabil. 1988 Feb;69(2):115-7
references.pmid: 3341889
references.citation: J Anat. 1964 Jul;98:437-53
references.pmid: 14193201
references.citation: Arthritis Rheum. 1988 Mar;31(3):441-6
references.pmid: 3282520