Effect of posterior tibial tendon dysfunction on unipedal standing balance test

Foot Ankle Int. 2015 Jan;36(1):83-9. doi: 10.1177/1071100714551020. Epub 2014 Sep 11.


Background: Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR).

Methods: Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher's exact test (2 × 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman's rho.

Results: The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR (P = .01). The AP and ML COP displacement were correlated with SLHR (r = -.538 and .495), respectively.

Conclusions: Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other.

Clinical relevance: A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance.

Level of evidence: Level III, case control study.

Keywords: balance; flat foot deformity; postural stability; tendon disorders; tibialis posterior.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Flatfoot / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Posterior Tibial Tendon Dysfunction / physiopathology*
  • Postural Balance*