Assessments Associated with the Diagnostics and Non-Surgical Treatment of Posterior Tibialis Tendon Dysfunction: A Systematic Review

Objectives: To investigate the efficacy of the assessment methods that are used to diagnose posterior tibialis tendon dysfunction (PTTD) and investigate how the results of these assessments can be used to instruct non-surgical treatments. Design: Systematic review. Data sources: Searches were conducted up to January 2023 in the PubMed, Scopus, Science Direct, Embase, Web of Science and Lilacs databases. Study eligibility criteria: Studies which included patients over 18 years of age, diagnosed with PTTD, which describe the assessments used to aid in the non-surgical treatment of PTTD in comparison with another type of assessment. All types of studies apart from protocols, letters to editor and other systematic reviews and meta-analysis were included. Study appraisal and synthesis methods: Two blinded reviewers performed screening, data extraction, and methodological quality assessments using the QUADAS-2. Results: A total of 15 observational studies were included in the review. Assessment methods included were verbal assessments, physical examinations, and imaging (magnetic resonance imaging (MRI), ultrasound (US), and radiographs). The single-heel rise test was a commonly mentioned physical examination, showing reliability in one study but contradicting in another. MRI was frequently described as the "gold standard". However, US showed both comparable accuracy and advantages compared to MRI, such as cost-effectiveness and real-time examinations. Conclusions: There are many assessment methods described in the literature and, due to the lack of accuracy of the tests, a mixture of tests should be used to assess PTTD. The parameters from the tests can provide a diagnosis of PTTD, but do not offer detail on how they assist the non-surgical treatment of the condition.