Prevalence of Posterior Tibial Tendon Dysfunction and Its Association with Foot Posture Among Overweight University Students

Abstract

Background: Posterior tibial tendon dysfunction (PTTD) compromises medial arch support and is linked with altered foot posture; however, data in young overweight populations are limited. Objective: To determine the prevalence of suspected PTTD and its association with foot posture among overweight university students. Methods: A cross-sectional observational study was conducted among 155 overweight students (18–30 years) recruited from universities in Lahore. BMI was calculated from standardized height and weight measures. Foot posture was assessed using the Foot Posture Index (FPI-6) and categorized as neutral, pronated/highly pronated, or supinated/highly supinated. Suspected PTTD was operationalized as positivity on the single-limb heel-rise test (performance failure and/or reproduction of medial ankle pain), and pain intensity was recorded using the Numeric Pain Rating Scale (NPRS). Associations between foot posture and heel-rise outcomes were examined using chi-square tests with effect size (Cramer’s V), and multivariable logistic regression adjusted for age, sex, and BMI. Results: The prevalence of suspected PTTD was 31.0% (48/155; 95% CI 23.8%–38.9%). Neutral posture was most common (55.5%), followed by pronated (20.0%) and highly pronated (11.0%). Heel-rise positivity increased with pronation severity (neutral 15.1%, pronated 48.4%, highly pronated 94.1%); the association was significant (χ²(4)=42.34, p<0.001; Cramer’s V=0.52). In adjusted analysis, pronated (aOR 4.72, 95% CI 1.78–12.50) and highly pronated posture (aOR 76.40, 95% CI 8.72–669.18) and BMI (aOR 1.18 per kg/m², 95% CI 1.01–1.38) predicted heel-rise positivity. Conclusion: Suspected PTTD was common in overweight university students and was strongly associated with increasingly pronated foot posture, supporting early screening and preventive strategies in young adults.