Introduction: Posterior tibial tendon dysfunction (PTTD), a key dynamic stabilizer of the hindfoot and the medial longitudinal arch, is an acquired progressive condition that most commonly affects women. It represents the leading cause of adult-acquired flatfoot deformity, which may result in collapse of the medial longitudinal arch, loss of tendon function, and alterations in gait and daily activities, significantly impacting quality of life. Purpose: The aim of this thesis was to analyze gait-related biomechanical changes in individuals with PTTD based on a review of the existing literature and to propose recommendations for physiotherapy management. Methods: Literature was retrieved from the PubMed database using the keywords posterior tibialis tendon dysfunction, gait analysis, gait, biomechanics, kinetics, kinematics. Open-access articles published between 2006 and 2024 that investigated gait-related biomechanical changes in individuals with PTTD were included. Results: Nine studies were included in the review. Participants with PTTD were, on average, older and had a higher body mass index compared to control groups. Kinematic analyses consistently reported slower walking speed, increased hindfoot eversion, forefoot abduction, and lowering of the medial longitudinal arch, particularly in advanced stages, where alterations were also observed in the midfoot. Kinetic analyses, conducted in only four studies, revealed reduced internal joint moments in the hindfoot, midfoot, knee, and hip, while reduced force generation was also reported in the hindfoot and midfoot in individual studies. Discussion and Conclusion: PTTD causes characteristic biomechanical alterations in gait, most pronounced during terminal stance and pre-swing phases, which trigger compensatory movement patterns at the knee and hip. Based on the identified gait alterations in PTTD, physiotherapy management should go beyond isolated strengthening of the tibialis posterior and include a comprehensive lower limb strengthening program alongside individually tailored interventions aimed at restoring functional gait patterns. Orthoses also play an important role, providing mechanical support to the foot and complementing the effects of exercise. The comparability of results is limited by methodological differences between studies and the inclusion of participants at different stages of PTTD, highlighting the need for standardization in future research. Despite these limitations, the findings provide important foundations for the development of targeted physiotherapy management for PTTD.
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