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

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Well done systematic review on Assessments associated with the diagnostics and non-surgical treatment of Posterior Tibialis Tendon Dysfunction, 

important topic and very relevant work.

Author Response

Author's Reply to the Review Report (Reviewer 1)

Well done systematic review on Assessments associated with the diagnostics and non-surgical treatment of Posterior Tibialis Tendon Dysfunction,

1. Dear reviewer, thank you for your comments.

Reviewer 2 Report

Comments and Suggestions for Authors

The aim of this study is to look at the efficacy of the assessment methods defined in the research, used to diagnose PTTD, as well as how the results of these assessments are used to instruct non-surgical treatment.

See attached file for comments.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Author Response

. Dear reviewer,

Thank you for giving us the possibility of addressing all the questions that arose during the review process. We think those comments have greatly improved the quality of this systematic review. Please find below all the responses in a point-by-point fashion. In the new revised version, the changes are highlighted in red font.

Page 2, RCTs? CT?

1. All of the included studies were observational studies. No randomized nor controlled trials were included because there are none that focus on PTTD.

Page 3, Put in parenthesis the names.

1. The parenthesis with the initials have been added.

Page 3, databases.

1. The spelling has been corrected.

Page 3, Put in parenthesis the names.

1. The parenthesis with the initials have been added.

Page 4, Put in parenthesis the names.

1. The parenthesis with the initials have been added.

Page 4, Put in parenthesis the names.

1. The parenthesis with the initials have been added.

 

Reviewer 3 Report

Comments and Suggestions for Authors

Dear authors,

We appreciate the effort and time put into conducting this research. However, there are minor corrections that need to be made to certain aspects of your document. Please review the following points:

1. Plagiarism: The plagiarism level in the paper should be reduced to below 20%. It is essential to maintain originality and provide accurate citations when using information from external sources.

2. Inclusion Criteria: Kindly specify the inclusion criteria for the articles included in the study. Some articles included are not aligned with the specified criteria. It would be beneficial to clarify if any specific congenital deformities were considered for inclusion.

3. Conclusion: In the conclusion section, it may be helpful to focus on the future implications of the research. For example, the conclusion could state: "The current assessment methods for posterior tibial tendon dysfunction (PTTD) exhibit limitations in terms of accuracy and precision. To improve the diagnosis of this condition, a combination of tests, including clinical evaluations, imaging studies, and laboratory testing, should be explored. This approach increases the validity and reliability of PTTD assessment, enabling healthcare providers to make more informed decisions regarding treatment. Further research is needed to validate this approach and explore the potential for developing more accurate assessment methods for PTTD."

Comments on the Quality of English Language

Quality of ENGLISH is very good

Author Response

1. Plagiarism: The plagiarism level in the paper should be reduced to below 20%. It is essential to maintain originality and provide accurate citations when using information from external sources.

The plagiarism is uploaded on the 20/2/2024. This was during the time that the paper was being reviewed. We hope that this won't cause an issue with publishing the paper. We have evidence that this is our work, including the PROSPERO registration and emails to other journals.

 

2. Inclusion Criteria: Kindly specify the inclusion criteria for the articles included in the study. Some articles included are not aligned with the specified criteria. It would be beneficial to clarify if any specific congenital deformities were considered for inclusion.

Changes have been made to this paragraph for added clarity:

 

Studies included in this review were ones focused on adults over 18 years of age diagnosed with PTTD. Studies were excluded if their focus was on patients who presented congenital deformity (i.e., accessory bones) or who presented some systemic disease (i.e., diabetes, rheumatoid arthritis) were excluded. However, studies were included if the study included participants with these conditions as part of the overall cohort.

Cadaver studies (in vitro) were also excluded.

 

 

3. Conclusion: In the conclusion section, it may be helpful to focus on the future implications of the research. For example, the conclusion could state: "The current assessment methods for posterior tibial tendon dysfunction (PTTD) exhibit limitations in terms of accuracy and precision. To improve the diagnosis of this condition, a combination of tests, including clinical evaluations, imaging studies, and laboratory testing, should be explored. This approach increases the validity and reliability of PTTD assessment, enabling healthcare providers to make more informed decisions regarding treatment. Further research is needed to validate this approach and explore the potential for developing more accurate assessment methods for PTTD."

 

Thank for you your suggestion, we agree that this conclusion is better written and therefore have included it in our paper.

Reviewer 4 Report

Comments and Suggestions for Authors

Thanks to the authors for the interesting topic.

 

The abstract results unclear in several parts. Authors should improve keywords: they should capture the essence of your paper. Keywords make your paper searchable and ensure that you get more citations.

Introduction appears unclear in classifications’ part.

Materials and methods: correct

Results: overall well presented. Table which resumes the studies is confusing.

Discussion: authors should describe the study's aim more clearly, detailing their starting point and the results they achieved.

Comments on the Quality of English Language

English language must be revised by a native speaker.

Author Response

The abstract results unclear in several parts.

 

abstract results changed to the following:

 

“Assessment methods included were verbal assessments, physical examinations, and imaging (Magnetic resonance imaging (MRI), ultrasound (US), and radiographs). The Single heel rise test was commonly mentioned physical examination, showing reliability in one study but contradicting in another. MRI was frequently described as the "gold standard", however US indicated both comparable accuracy and advantages compared to MRI, such as cost-effectiveness and real-time examinations.”

 

Authors should improve keywords: they should capture the essence of your paper. Keywords make your paper searchable and ensure that you get more citations.

 

We have added “Treatment, Orthotics and Physiotherapy”. If you have any suggestions as to what you feel would be more appropriate, then we would be happy to consider them.

 

 

Introduction appears unclear in classifications’ part.

Changes have been to this paragraph for added clarity:

 

“Due to the evolving nature of the condition, many authors have divided the condition into stages, to better guide treatment methodology. Johnson and Storm were the first to stage the condition in 1989 [6]. This was later revised by multiple authors, including Myerson in 1996 [7] which further revised by Bluman et al. in 2007 [8]. In 2012, Raikin et al. developed the Rearfoot Ankle Midfoot (RAM) classification, which has also been modified from the original Johnson and Storm system, and introduces more detail regarding the rearfoot, ankle and midfoot [9].”

 

Materials and methods: correct

Thank you

 

Results: overall well presented. Table which resumes the studies is confusing.

 

We have made extensive changes to the table, including the results section which we have add more detail and have put this to its own table to make it less cluttered.

 

Discussion: authors should describe the study's aim more clearly, detailing their starting point and the results they achieved.

 

The following phrase has been added to the aim within the discussion:

 

“It has been shown that the assessment methodology used in the diagnosis and classification of PTTD presents limitations in terms of accuracy and precision, being necessary to combine of tests. This can then inform practitioners in the most appropriate assessment methodology for the condition, ensuring that their practice is evidence based.”

 

Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

Thank you for corrections. I appreciated the revised version, and read it carefully.