title: Effects of foot orthoses on the work of friction of the posterior tibial tendon.
abstract: BACKGROUND
  Posterior tibial tendon dysfunction is a significant contributor to flatfeet. Non-operative treatments, like in-shoe orthoses, have varying degrees of success. This study examined changes to the work of friction of the posterior tibial tendon under three conditions: intact, simulated flatfoot, and flatfoot with an orthosis. It was hypothesized that work of friction of the posterior tibial tendon would significantly increase in the flatfoot, yet return to normal with an orthosis. Changes to bone orientation were also expected.
  
  
  METHODS
  Six lower limb cadavers were mounted in a foot simulator, that applied axial and a posterior tibial tendon load. Posterior tibial tendon excursion, gliding resistance, and foot kinematics were monitored, and work of friction calculated. Each specimen moved through a range of motion in the coronal, transverse, and sagittal planes.
  
  
  RESULTS
  Mean work of friction during motion in the coronal plane were 0.17 N cm (SD 0.07 N cm), 0.25 N cm (SD 0.09 N cm), and 0.23 N cm (SD 0.09 N cm) for the intact, flatfoot, and orthosis conditions, respectively. Motion in the transverse plane yielded average WoF of 0.36 N cm (SD 0.28 N cm), 0.64 N cm (SD 0.25 N cm), and 0.57 N cm (SD 0.38 N cm) in the same three conditions, respectively. The average tibio-calcaneal and tibio-metatarsal valgus angles significantly increased in the flatfoot condition (5.8 degrees and 9 degrees , respectively). However, the orthosis did slightly correct this angle.
  
  
  CONCLUSIONS
  The prefabricated orthosis did not consistently restore normal work of friction, though it did correct the flatfoot visually. This implies that patients with flatfeet may be predisposed to developing posterior tibial tendon dysfunction due to abnormal gliding resistance, though bone orientations are restored.
authors.affiliation: Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN 55095, USA.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Hirano
authors.forename: Matthew B A
authors.initials: MB
authors.lastname: McCullough
authors.forename: Harold B
authors.initials: HB
authors.lastname: Kitaoka
authors.forename: Kazuya
authors.initials: K
authors.lastname: Ikoma
authors.forename: Kenton R
authors.initials: KR
authors.lastname: Kaufman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003198:Computer Simulation; D055119:Elastic Modulus; D005260:Female; D005413:Flatfoot / Q000503:physiopathology* / Q000534:rehabilitation*; D005528:Foot / Q000503:physiopathology*; D017276:Friction; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009989:Orthotic Devices; D013314:Stress, Mechanical; D013710:Tendons / Q000503:physiopathology*; D013977:Tibia / Q000503:physiopathology*