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. 2017 Apr;35(4):910-915.
doi: 10.1002/jor.23338. Epub 2016 Jun 23.

Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion

Ruth L Chimenti  1 , Mary Bucklin  2 , Meghan Kelly  3 , John Ketz  3 , Adolph Samuel Flemister  3 , Michael S Richards  4 , Mark R Buckley  2
Affiliations

Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion

Ruth L Chimenti et al. J Orthop Res. 2017 Apr.

Abstract

The purposes of this case-control study (N = 20) were to examine the effects of insertional Achilles tendinopathy (IAT) and tendon region on tendon strain in patients with IAT compared to a control group without tendinopathy. An ultrasound transducer was positioned over the Achilles tendon insertion during dorsiflexion tasks, which included standing and partial squat. A non-rigid image registration-based algorithm was used to estimate transverse compressive and axial tensile strains of the tendon from radiofrequency ultrasound images, which was segmented into two regions (superficial tendon and deep). For transverse compressive strain, two-way mixed effects ANOVAs demonstrated that there were interaction effects between group and tendon region for both dorsiflexion tasks (Heel lowering, p = 0.004; Partial squat, p = 0.008). For axial tensile strain, the IAT group demonstrated a main effect of lower tensile strain than the control group (Standing, p = 0.001; Partial squat, p = 0.033). There was also a main effect of greater tensile strain in the superficial region of the tendon compared to the deep during standing (p = 0.002), but not during partial squat (p = 0.603). Reduced transverse compressive and axial tensile strains in the IAT group indicate altered mechanical properties specific to the region of IAT pathology. Additionally, patterns of compressive strain are consistent with the theory of calcaneal impingement contributing to IAT pathology. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:910-915, 2017.

Keywords: Achilles tendonitis; heel lift; tendon mechanics; ultrasound elastography.

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Figures

Figure 1
Figure 1
Dorsiflexion tasks started from the position shown in image a with the back of the platform raised to a 17° inclination to plantarflex the ankle. The two tasks include: (1) standing (a) to (b), and (2) partial squat (a) to (b) to (c). The tape indicates the location of the fibular head and the lateral malleolus.
Figure 2
Figure 2
Image series for a participant with insertional Achilles tendinopathy during a partial squat demonstrating (a) the superficial region, outlined in solid blue, and deep region, outlined in dashed blue line, of the Achilles tendon insertion, (b) green lines represent the principal strain directions, (c) transverse compressive strain map, and (d) axial tensile strain map. Images (e) and (f) are, respectively, the transverse compressive and axial tensile strain maps for a participant without insertional Achilles tendinopathy during the partial squat task. All images have dimensions of 20 mm by 38 mm.
Figure 3
Figure 3
Ultrasound elastography was utilized to measure the (a) transverse compressive strain and (b) axial tensile strain of the Achilles tendon while participants performed a partial squat. For transverse compressive strain, there was an interaction effect between group and tendon region. For axial tensile strain, there were main effects of group and tendon region. Data are presented as mean ± SD, * P < 0.05.
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References

    1. Uquillas CA, Guss MS, Ryan DJ, et al. Everything Achilles: Knowledge Update and Current Concepts in Management: AAOS Exhibit Selection. J Bone Joint Surg Am. 2015;97:1187–1195. - PubMed
    1. Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, et al. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2013;21:1345–1355. - PubMed
    1. Kearney R, Costa ML. Insertional achilles tendinopathy management: a systematic review. Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 2010;31:689–694. - PubMed
    1. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles tendinosis based on MRI. Foot Ankle Int. 2007;28:472–477. - PubMed
    1. Yodlowski ML, Scheller AD, Jr, Minos L. Surgical treatment of Achilles tendinitis by decompression of the retrocalcaneal bursa and the superior calcaneal tuberosity. The American Journal of Sports Medicine. 2002;30:318–321. - PubMed

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