Consensus among health-care practitioners surrounding the assessment and diagnosis of tibialis posterior tendon dysfunction (TPTD)

In recent months there have been suggestions that TPTD is poorlydiagnosed. Inconsistency in assessment protocols has been postulatedas being a contributing factor. To further explore this hypothesis, amodified Delphi technique was employed to gather multidisciplinaryexpert opinion in the areas of assessment and diagnosis of TPTD. Thelevel of agreement among the participants was analyzed using Kendall’scoefficient of concordance on the ratings for the closed questionsand percent agreement for the open-ended responses. The initialquestionnaire analysis revealed that for some areas there was a lackof agreement among health care practitioners. Thematic analysis offocus group discussions showed that lack of concordance was partlydue to a varied scope of practice between professional groups. Thesedifferences in practice could be well justified, for example some practitionersmay not conduct a detailed weight-bearing assessment andmay decide that onward referral to a foot and ankle specialist is indicated.Others, however, would carry out such an assessment andmake a clinical diagnosis based on their findings. Another example isdiagnostic imaging. For surgical assessment imaging is often a prerequisitewhereas this may not be the case for non-surgical management,and therefore a lack of concordance would be expected.