posterior muscle and affect eccentric pronation control.

DIAGNOSIS

During assessment, the therapist should use differential diagnosis to ascertain that the problem is associated with the tibialis posterior muscle. Other possible injured structures to examine and discount include the deltoid ligament and damage to the medial malleolus

or tarsal bones. Problems with the tibialis posterior tendon generally have a gradual onset, unless direct trauma is involved. Most active people will not stop their activities due to a tibialis posterior problem, but they will experience pain during activity. Aggravating factors such as walking (5) and uneven surfaces (2,3) will be reported.

Initially the patient may report discomfort by palpation over the tibialis BOX 1: CASE STUDY

CHANGES OF DIRECTION CAN BE SUBJECT TO TENDON DYSFUNCTION

ANY SPORTS INVOLVING RAPID

DESCRIPTION A 25-year-old semi-professional footballer experienced a contusion to the medial aspect of his ankle. He continued to play for the remainder of the match and applied ice as soon as the match ended. On assessment by the club physiotherapist, he was diagnosed as having a problem with the deltoid ligament of the ankle. He was treated with rest, ice, ultrasound and gentle mobilisations. After 6 weeks of rest, however, the problem was not responding to treatment and was getting worse. The patient complained of a “deep, dull ache” over the medial aspect of the ankle and foot. It was aggravated by walking, and the patient was unable to run without pain. He had pain on palpating over the tibialis posterior tendon. When I first saw the patient at this stage following his injury, he was understandably frustrated about not being able to play and the fact that the treatment did not seem to be working. After an assessment, a diagnosis of tibialis posterior dysfunction was made. The initial stage in treatment was to apply the low-dye taping technique. Following this, the patient was asked to attempt light jogging to test out the injury. With the help of the taping technique, the patient was able to run lightly on the injury. Over the following week, the tape was re-applied when needed; the patient trained with his team mates and even managed to secure a place on the bench for the following weekend match. With the knowledge that we had now pinpointed the exact problem, a programme of exercises was begun to strengthen around the area in order to build up the medial arch. During this time, the taping technique was applied for training and matches, and the patient played regularly for the full 90 minutes. Over the next 6 weeks, the player’s medial arch began to return with the exercises, and therefore the taping was needed less often; eventually, the area was deemed strong enough to not require the tape to be applied.

Figures 2a and 2b: Place a strip of tape from the head of the fifth metatarsal and around the heel, and finish at the head of the first metatarsal. This will act as an anchor

Figure 3: Using 2-inch non-elastic tape, and starting from the lateral aspect of the foot, place the tape over the base of the foot. Be careful not to pull here, as it may cause discomfort. Once the tape is close to the medial aspect of the foot, pull upwards on the tape to hold up the medial foot arch

posterior tendon, but there may also be an ache over the plantar aspect of the medial foot (5). The main area of tenderness usually centres over the pivot point around the medial malleolus. This may be explained due to relative hypovascularity in this area. Therefore, any microtrauma that occurs may not heal as quickly in this area as in other areas of the tendon. Resisted plantarflexion combined with inversion

Figure 4: Apply the tape across the bottom of the foot, making sure each strip overlaps to cover the whole of the medial arch

Figure 5: To finish, place a final strip around the foot from the head of the fifth metatarsal to the first metatarsal to secure

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sportEX dynamics 2009;21(Jul):11-13