# Relevance of Tibial Fixation during Tibiotarsal Joint Traction: Descriptive Cross-Sectional Study

## TL;DR

This study examines how tibial fixation affects talus movement during a joint traction technique, finding that fixation increases movement and reduces discomfort.

## Contribution

The study introduces a novel evaluation of tibial fixation's impact on talus movement during TATT in healthy subjects.

## Key findings

- Tibial fixation produced greater talus movement compared to non-fixation conditions.
- The technique showed good reliability in detecting applied force magnitudes.
- Tibial fixation was associated with higher tolerability and lower discomfort.

## Abstract

Background: The effect of tibial fixation on the movement of the talus during the tibiotarsal axial traction technique (TATT) is unknown. The aim was to evaluate the effect on the tibiotarsus when applying three different intensities of TATT force with or without tibial fixation in healthy subjects, and to assess the reliability of detecting the different forces applied. Also, the discomfort generated during the technique would be analysed. Methods: A cross-sectional study was conducted in thirty lower limbs. Three magnitudes of TATT force in an open-packed position were applied in tibial fixation and non-fixation conditions. The axial traction movement was measured by ultrasound, and the magnitudes of the force applied during low-medium and high TATT force were recorded in both conditions. Patients were asked about the level of discomfort perceived during the technique. Results: The most significant distance increase (mm) was observed in the tibial fixation condition at all magnitudes of the TATT (F = 102.693, p < 0.001). The discomfort sensation (numeric rating scale, “NRS”) was higher in the non-fixation condition (p > 0.05). The application of the technique showed good reliability (>0.75 ICC) for the detection of the applied force. Conclusions: The TATT in the tibial fixation condition produced more significant axial movement of the talus (mm) relative to the tibia than the non-tibial fixation condition did. The detection of the magnitudes of movement showed good reliability (ICC: 0.75 to 0.92). The technique was well tolerated at all force magnitudes, with the tibial fixation condition being the most tolerable.