Biomechanical evaluation of the spring ligament and the posterior tibial tendon by shear-waves elastography: validation of a reliable and reproducible measurement protocol

Abstract

PurposeThe anatomy of the spring ligament complex, as well as its pathology, is not well known in daily clinical practice. The purpose of this study was to evaluate the shear-wave elastography properties of the spring ligament and the posterior tibial tendon in healthy adults, and to assess the reliability and reproducibility of these measurements.MethodsShear-wave elastography was used to evaluate both ankles in 20 healthy patients (10 females/10 males) resting on a hinge support with their ankles in neutral, valgus 20° and varus 30° positions. The stiffness of the spring ligament and posterior tibial tendon was assessed by measuring the speed of shear wave propagation through each structure.ResultsPosterior tibial tendon and spring ligament reach a maximum estimated stiffness in valgus 20° position (7.43 m/s vs 5.73 m/s, respectively). Flat feet were associated with greater spring ligament stiffness in the 20° valgus position (p = 0.01), but not for the posterior tibial tendon (p = 0.71). The physiologic weightbearing hindfoot attitude had no impact on the stiffness of the posterior tibial tendon or the spring ligament, regardless of the analysis position. Intra- and inter-observer agreements were all excellent for spring ligament stiffness, regardless of ankle position, and were good or excellent for posterior tibial tendon.ConclusionsThis study describes a protocol to assess the stiffness of tibialis posterior and the spring ligament by shear-wave elastography, which is reliable, reproducible, and defines a corridor of normality. Further studies should be conducted to define the role of elastography for diagnosis/ evaluation of pathology, follow-up, or surgical strategies.