Effect of Bracing and Strengthening Exercises on Posterior Tibial Tendon Dysfunct

描述（由申请人提供）：本项目将比较支撑和强化运动（被动和主动治疗的组合）与支撑和伸展运动（被动治疗）对II期胫骨后肌腱功能障碍（PTTD）受试者的影响。目前的临床证据表明，主动治疗而非被动治疗可改善患有其他下肢肌腱病（例如跟腱病）的受试者的临床结果。我们的假设是，与接受被动治疗（支撑和伸展运动）的II期PTTD受试者相比，主动治疗（支撑和加强运动）将改善足部运动学、胫骨后肌长度、等长肌力和功能状态。研究中纳入的所有受试者将患有II期PTTD，由整形外科医生诊断。本研究设计为前瞻性、单盲、对照试验。干预是支撑和加强练习。对照治疗是支撑和伸展运动。主要结果变量包括足部运动学、胫后肌长度、等长肌力和有效的自我评估量表。从运动分析确定的关键结果变量将包括异常足部运动学和胫骨后肌长度。异常的足部运动学是PTTD进展的关键指标，预计加强锻炼可以改善PTTD进展（具体目标#1a）。将使用基于足部运动学的经确认模型来确定足部运动学的改善是否提示肌肉长度缩短（特定目标#1b）。等长力量测试预计将记录强化锻炼（干预）相对于被动治疗（对照）的有效性（具体目标#2），表明胫骨后肌功能恢复。自我评估量表在多大程度上提供了一种判断干预和对照治疗对功能的总体影响的方法（具体目标#3），与单独的支撑和伸展（被动治疗）相比，预计强化练习（主动治疗）将显示出更大的功能增加。在这项临床试验的结论，我们将确定是否有一个加强支具和伸展与加强运动治疗II期PTTD的好处。本提案将采用随机对照试验设计，评估限制性较小的支具通过强化练习增强的效果。如果成功的支具加强练习可以替代矫形手术。由于这种保守的治疗方法（通过加强支撑）通常不会干扰工作，成本低于骨科手术，并且与较少的不良事件（例如感染）相关，因此对个人和社会都有明显的益处。

DESCRIPTION (provided by applicant): This project will compare the effects of bracing and strengthening exercises, a combination of passive and active treatments, to bracing and stretching exercises, passive treatments, for subjects with stage II posterior tibial tendon dysfunction (PTTD). Current clinical evidence suggests active treatments, not passive, lead to improved clinical results in subjects with other lower limb tendinopathies (e.g. Achilles tendinopathy). Our hypothesis is that active treatment (bracing and strengthening exercises) will lead to improved foot kinematics, posterior tibial muscle length, isometric strength and functional status as compared to subjects receiving passive treatment (bracing and stretching exercises) for stage II PTTD. All subjects included in the study will have stage II PTTD, diagnosed by an orthopedic surgeon. The study is designed to be a prospective, single blind, controlled trial. The intervention is bracing and strengthening exercises. The control treatment is bracing and stretching exercises. The primary outcome variables include foot kinematics, posterior tibial muscle length, isometric strength and validated self assessment scales. The key outcome variables determined from motion analysis will include abnormal foot kinematics and posterior tibial muscle length. Abnormal foot kinematics is a key indicator of PTTD progression which strengthening exercises are expected to improve (Specific Aim #1a). A validated model based on foot kinematics will be used to determine if improvements in foot kinematics are suggestive of shorter muscle length (Specific Aim #1b). Isometric strength tests are expected to document the effectiveness of the strengthening exercise (intervention) over passive treatments (control) (Specific Aim #2), suggesting restoration of posterior tibial muscle function. The extent to which the self assessment scales provide a means to judge the overall effect of the intervention and control treatments on function (Specific Aim #3), strengthening exercises (an active treatment) are expected to show greater increases in function compared to bracing and stretching alone (passive treatments). At the conclusion of this clinical trial we will determine if there is a benefit of augmenting bracing and stretching with strengthening exercises for treatment of stage II PTTD. This proposal will evaluate the effect of a less restrictive brace augmented by strengthening exercises, using a randomized controlled trial experimental design. If successful bracing augmented with strengthening exercises could be an alternative to orthopedic surgery. Because this conservative management approach (bracing augmented by strengthening) does not usually interfere with work, costs less than orthopedic surgery and is associated with fewer adverse events (e.g. infection) there is a clear benefit to the individual and society.