Home-based general versus center-based selective rehabilitation in patients with posterior tibial tendon dysfunction

Objective: The aim of this study was to compare the effect of home-based and supervised center-based selective rehabilitation in patients with Grade 1 to 3 posterior tibial tendon dysfunction (PTTD).Methods: The study included 49 subjects diagnosed with PTTD and referred to physiotherapy by an orthopedic surgeon. Subjects were randomly assigned into a home-based rehabilitation (21 cases; mean age: 33.56±17.59) group or center-based rehabilitation (28 cases; mean age: 28.57±14.74 years).The patients in the home-based rehabilitation group followed a home program of cold application, strengthening exercises for the posterior tibial and intrinsic muscles, and stretching in the subtalar neutral position. The patients in the center-based rehabilitation group followed a selective, supervised treatment consisting of the home protocol plus re-education of the non-functional tibialis posterior, proprioceptive neuromuscular facilitation methods, electrical stimulation, joint mobilization and taping techniques. Both groups received appropriate orthotics. All subjects were assessed before and after treatment for pain, muscle strength, foot function index (FFI) scores and specific tests for PTTD.Results: Statistical analysis showed significant differences between pre- and post-treatment results for pain, first metatarsophalangeal angle, forefoot abduction angle, FFI scores and foot and ankle muscle strengths in the center-based group and for the tibialis posterior muscle strength in the home-based group (p 0.05). Intergroup comparison, however, showed no differences between the groups at the end of the treatment program with the exception of posterior tibial muscle strength (p 0.05).Conclusion: Home- and center-based forms of rehabilitation seem to be equally effective in relieving pain and improving functional outcome in patients with Grade 1 to 3 PTTD. A patient-selective, supervised program may provide a better improvement in tibialis posterior strength than home-based rehabilitation.