Patient Factors in the Selection of Operative Versus Nonoperative Treatment for Posterior Tibial Tendon Dysfunction

Background: The influence of demographic, medical history, and treatment variables on the maintenance of nonoperative care or progression to operative intervention in Posterior Tibial Tendon Dysfuction (PTTD) was explored. This retrospective study compared demographic, medical history and treatment variables between operative and nonoperative care in subjects with PTTD. Materials and Methods: Charts with the ICD-9 codes (726.72, 726.90) and brace distribution records for 2005 and 2006 were used to identify subjects. From these, 166 of 606 charts included documentation of PTTD. Variables were grouped into three categories including demographics (Age, body mass index, gender and working status), medical (stage, symptom duration, pain at initial evaluation, and past treatments) and treatment (initial brace, length of care episode, and brace change). Statistical comparisons between subjects treated nonoperatively and operatively were made. Significant variables were entered into a logistic regression analysis. Accuracy (sensitivity/specificity) was assessed by examining the success of predicting which subjects were treated operatively or nonoperatively. Results: Of the 166 subjects, 125 (75.4%) received nonoperative care and 41 (24.6%) operative care. Nine variables distinguished the operative from the nonoperative group (p \u3c 0.05): including BMI, work status, stage, symptom duration, prior orthotic use, prior injection, custom brace, brace changes, and length of care episode. The logistic regression model identified BMI, symptom duration, prior cortisone injections, and prior orthotic use as significant and resulted in a specificity of 95.4% and sensitivity of 38.2%. Conclusion: This retrospective analysis provides a patient profile of factors in the success of nonoperative care in PTTD