Achilles Tendon Moment Arm Research Articles

Open Dorsal Closing-Wedge Calcaneal Osteotomy for Haglund Exostosis-Related Heel Pain.

Dorsal closing-wedge calcaneal osteotomy (DCWCO) is a treatment option for persistent Haglund exostosis-related heel pain after failed conservative management. In modifying the orientation of the calcaneal tendinous insertion site and reducing mechanical stress, the consequences of DCWCO-associated biomechanical changes on everyday foot function remain unknown. This retrospective cohort study analyzed routinely collected clinical data as well as data from our foot and ankle registry. One hundred twenty patients (66 males, 54 females, 17-77 years) who underwent DCWCO from January 2016 to December 2019 were included. Adverse events were collected from the patient files. Foot Function Index (FFI) scores were collected before (baseline) and at 6, 12, and 24 months postsurgery. Radiographic parameters including the Achilles tendon moment arm and X/Y ratio were evaluated from standard preoperative and 6-week postoperative radiographs. Correlations between FFI and biomechanical changes were calculated for men and women separately with the Pearson correlation coefficient and Bonferroni correction. One intra- and 18 postoperative adverse events were documented. Mean baseline FFI pain decreased from 47.9 ± 17.2 to 12.0 ± 17.5 points at 24 months with an average decrease of -21.8 ± 21.3 points occurring within the first 6 months postsurgery. A similar trend was also seen with the FFI disability score (49.6 ± 20.3 to 12.8 ± 17.6 points). The mean decrease in Achilles tendon moment arm was -8.1 ± 3.8 mm and mean X/Y ratio increased from 2.6 ± 0.3 to 3.8 ± 1.0. There were no significant correlations between the FFI score and radiographic changes. DCWCO effectively alleviates exostosis-related heel pain and associated disabilities. Improvements can still be expected up to 2 years after surgery. Radiographic changes of the foot and ankle are significant but do not correlate with patient-reported outcome measures.

Correlations between Achilles tendon moment arm and plantarflexor muscle architecture variables.

The production of triceps surae plantarflexion moment is complex in that the Achilles tendon moment arm affects the Achilles tendon force by determining the muscle length change and shortening velocity during ankle rotation. In addition, there is evidence for associations between the sizes of muscles and their moment arm at the joints they span. These relationships between muscle architecture and tendon moment arm ultimately affect the muscle's force generating capacity and are thus important for understanding the roles played by muscles in producing locomotion. The purpose of this study was to investigate in vivo the relationship between architecture of two plantarflexors and the Achilles tendon moment arm in a healthy adult population. Ultrasound-based measurements were made of the architecture (fascicle length, muscle volume, physiological cross-sectional area, and anatomical cross-sectional area) of the lateral and medial gastrocnemius and the Achilles tendon moment arm was assessed using a technique that combined ultrasound imaging and motion analysis. Positive correlations were observed between the length (r = 0.499, p = 0.049) and size variables (muscle volume r = 0.621, p = 0.010; ACSA r = 0.536, p = 0.032) of the lateral gastrocnemius and the Achilles tendon moment arm, but correlations were only observed for size variables (muscle volume r = 0.638, p = 0.008; PCSA r = 0.525, p = 0.037; ACSA r = 0.544, p = 0.029), and not the length, of the medial gastrocnemius. These findings suggest lateral gastrocnemius adapts to moment arms to maintain force production throughout the range of motion across individuals, while the medial gastrocnemius does not and is thus better suited for static force generation.

A longer Achilles tendon moment arm length is not associated with superior hopping performance.

Variability in musculoskeletal and lower leg structure has the potential to influence hopping height. Achilles tendon moment arm length and plantarflexor muscle strength can influence ankle joint torque development and, consequently, hopping performance. While most studies have examined the connection of the Achilles tendon moment arm with hopping performance including the resting length, in this study we attempted to explore how the changes in Achilles tendon moment arm are related to hopping performance. Therefore, the purpose of this study was to test for correlations between foot and lower leg muscle structure parameters (i.e., muscle mass, volume, cross-sectional area and Achilles tendon moment arm length) and hopping height performance in relation to changes in Achilles tendon moment arm length. Eighteen participants (10 males 8 female) performed repetitive bilateral hopping on a force platform while sagittal plane kinematics of the lower leg were recorded. Additionally, maximal isometric plantarflexion was measured. To obtain structural parameters of the lower leg, the right lower leg of each participant was scanned with magnetic resonance imaging. The cross-sectional areas of the Achilles tendon, soleus, lateral and medial gastrocnemius were measured, while muscle volumes, muscle mass, and Achilles tendon moment arm length were calculated. Contrary to our initial assumption, longer Achilles tendon moment arm did not result in superior hopping performance. Interestingly, neither maximal isometric plantarflexion force nor muscle size correlated with repetitive bilateral hopping performance. We can assume that the mechanical characteristics of the tendon and the effective utilization of the stored strain energy in the tendon may play a more important role in repetitive hopping than the structural parameters of the lower leg.

How do differences in Achilles' tendon moment arm lengths affect muscle-tendon dynamics and energy cost during running?

The relationship between the Achilles tendon moment arm length (ATMA) and the energy cost of running (Erun) has been disputed. Some studies suggest a short ATMA reduces Erun while others claim a long ATMA reduces Erun. For a given ankle joint moment, a short ATMA permits a higher tendon strain energy storage, whereas a long ATMA reduces muscle fascicle force and muscle energy cost but shortening velocity is increased, elevating the metabolic cost. These are all conflicting mechanisms to reduce Erun, since AT energy storage comes at a metabolic cost. Neither of these proposed mechanisms have been examined together. We measured ATMA using the tendon travel method in 17 males and 3 females (24 ± 3 years, 75 ± 11 kg, 177 ± 7 cm). They ran on a motorized treadmill for 10 min at 2.5 m · s-1 while Erun was measured. AT strain energy storage, muscle lengths, velocities and muscle energy cost were calculated during time-normalized stance from force and ultrasound data. A short (SHORT n = 11, ATMA = 29.5 ± 2.0 mm) and long (LONG, n = 9, ATMA = 36.6 ± 2.5 mm) ATMA group was considered based on a bimodal distribution of measured ATMA. Mean Erun was 4.9 ± 0.4 J · kg-1 · m-1. The relationship between ATMA and Erun was not significant (r 2 = 0.13, p = 0.12). Maximum AT force during stance was significantly lower in LONG (5,819 ± 1,202 N) compared to SHORT (6,990 ± 920 N, p = 0.028). Neither AT stretch nor AT strain energy storage was different between groups (mean difference: 0.3 ± 1 J · step-1, p = 0.84). Fascicle force was significantly higher in SHORT (508 ± 93 N) compared to LONG (468 ± 84 N. p = 0.02). Fascicle lengths and velocities were similar between groups (p > 0.72). Muscle energy cost was significantly lower in LONG (0.028 ± 0.08 J · kg · step-1) compared to SHORT (0.045 ± 0.14 J · kg · step-1 p = 0.004). There was a significant negative relationship between ATMA and total muscle energy cost relative to body mass across the stance phase (r = -0.699, p < 0.001). Together these results suggest that a LONG ATMA serves to potentially reduce Erun by reducing the muscle energy cost of the plantarflexors during stance. The relative importance of AT energy storage and return in reducing Erun should be re-considered.

Does the Achilles Tendon Influence Foot Strike Patterns During an Exhaustive Run?

The study purpose was to investigate whether there is a relationship between the Achilles tendon (AT) length, moment arm length, and the foot strike pattern (FP) change during an exhaustive run (EXR) in nonrearfoot FP runners. Twenty-eight runners were recruited and divided into 2 groups (highly trained/moderately trained) according to their weekly training volume. Participants underwent the graded exercise test, the EXR with biomechanical analysis at the beginning, and at the end, and the magnetic resonance imaging scan of the AT. Correlations were used to assess associations between FP change (value of the difference between end and beginning) and the selected performance and AT variables. AT length significantly correlated with the FP change according to foot strike angle (r = -.265, P = .049). The AT moment arm length significantly correlated with the FP change according to strike index during EXR (r = -.536, P = .003). Multiple regression showed that AT length was a significant predictor for the FP change according to foot strike angle if the second predictor was the graded exercise test duration and the third predictor was training group association. These results suggest that a runner's training volume, along with a longer AT and AT moment arm appear to be associated with the ability to maintain a consistent FP during EXR by nonrearfoot FP runners.

Muscle-tendon architecture in Kenyans and Japanese: Potential role of genetic endowment in the success of elite Kenyan endurance runners.

The specificity of muscle-tendon and foot architecture of elite Kenyan middle- and long-distance runners has been found to contribute to their superior running performance. To investigate the respective influence of genetic endowment and training on these characteristics, we compared leg and foot segmental lengths as well as muscle-tendon architecture of Kenyans and Japanese males (i) from infancy to adulthood and (ii) non-athletes versus elite runners. The 676 participants were divided according to their nationality (Kenyans and Japanese), age (nine different age groups for non-athletes) and performance level in middle- and long-distance races (non-athlete, non-elite and elite adult runners). Shank and Achilles tendon (AT) lengths, medial gastrocnemius (MG) fascicle length, pennation angle and muscle thickness, AT moment arm (MAAT ), and foot lever ratio were measured. Above 8years old, Kenyans had a longer shank and AT, shorter fascicle, greater pennation angle, thinner MG muscle as well as longer MAAT , with lower foot lever ratio than age-matched Japanese. Among adults of different performance levels and independently of the performance level, Kenyans had longer shank, AT and MAAT , thinner MG muscle thickness, and lower foot lever ratio than Japanese. The decrease in MG fascicle length and increase pennation angle observed for the adult Japanese with the increase in performance level resulted in a lack of difference between elite Kenyans and Japanese. The specificity of muscle-tendon and foot architecture of elite Kenyan runners could result from genetic endowment and contribute to the dominance of Kenyans in middle- and long-distance races.

Children who idiopathically toe-walk have greater plantarflexor effective mechanical advantage compared to typically developing children

PurposeThe effective mechanical advantage (EMA) of the plantarflexor muscles is important for gait function and is likely different from typical in equinus gait. However, this has never been quantified for children who idiopathically toe-walk (ITW), despite being routinely altered through clinical intervention.MethodsThis study quantified the Achilles tendon and ground reaction force (GRF) moment arms, and the plantarflexor EMA of 5 children who ITW and 14 typically developing (TD) children, whilst walking on an instrumented treadmill.ResultsThere was no difference in the Achilles tendon moment arm length throughout stance between groups (p > 0.05). Children who ITW had a significantly greater GRF moment arm length in early stance (20–24% p = 0.001), but a significantly shorter GRF moment arm length during propulsion (68–74% of stance; p = 0.013) than TD children. Therefore, children who ITW had a greater plantarflexor EMA than TD children when active plantarflexion moments were being generated (60–70% of stance; p = 0.007). Consequently, it was estimated that children who ITW required 30% less plantarflexor muscle force for propulsion.ConclusionClinical decision making should fully consider that interventions which aim to restore a typical heel-toe gait pattern risk compromising this advantageous leverage and thus, may increase the strength requirements for gait.

Shorter heels are linked with greater elastic energy storage in the Achilles tendon

Previous research suggests that the moment arm of the m. triceps surae tendon (i.e., Achilles tendon), is positively correlated with the energetic cost of running. This relationship is derived from a model which predicts that shorter ankle moment arms place larger loads on the Achilles tendon, which should result in a greater amount of elastic energy storage and return. However, previous research has not empirically tested this assumed relationship. We test this hypothesis using an inverse dynamics approach in human subjects (n = 24) at speeds ranging from walking to sprinting. The spring function of the Achilles tendon was evaluated using specific net work, a metric of mechanical energy production versus absorption at a limb joint. We also combined kinematic and morphological data to directly estimate tendon stress and elastic energy storage. We find that moment arm length significantly determines the spring-like behavior of the Achilles tendon, as well as estimates of mass-specific tendon stress and elastic energy storage at running and sprinting speeds. Our results provide support for the relationship between short Achilles tendon moment arms and increased elastic energy storage, providing an empirical mechanical rationale for previous studies demonstrating a relationship between calcaneal length and running economy. We also demonstrate that speed and kinematics moderate tendon performance, suggesting a complex relationship between lower limb geometry and foot strike pattern.

Measurement of instantaneous Achilles tendon moment arm and force during the stance phase of running

Accurate estimates of the Achilles tendon (AT) moment arm (ATMA) are necessary for investigating triceps surae muscle-tendon unit loading and function. There are limited reported values of ATMA during running. By combining ultrasound and motion capture, ATMA was estimated during the stance phase of running. Group mean ATMA was estimated at 49.2 ± 3.8 mm and 37.5 ± 5.3 mm, relative to the centre of rotation (malleoli markers midpoint) and the ankle finite helical axis respectively. Differences in the corresponding estimated AT forces reached up to 3100 N approximately. Such discrepancies can lead to misinterpretation of the whole muscle-tendon unit function.

Longer Achilles tendon moment arm results in better running economy.

Based on the current literature, the link between Achilles tendon moment arm length and running economy is not well understood. Therefore, the aim of this study was to further investigate the connection between Achilles tendon moment arm and running economy and the influence of Achilles tendon moment arm on the function of the plantarflexor muscle-tendon unit during running.Ten male competitive marathon runners volunteered for this study. The participants ran on a treadmill at two running speeds: 3 and 3.5 m s-1. During running the oxygen consumption, lower leg kinematics, electrical activity of plantar flexor muscles, and fascicle behavior of the lateral gastrocnemius were measured simultaneously. On the second occasion, an MRI scan of the right leg was taken and used to estimate the Achilles tendon moment arm length.There was a negative correlation between running economy and the body height normalized moment arm length at both selected speeds (r = -0.68, P = 0.014 and r = -0.70, P = 0.01). In addition, Achilles tendon moment arm length correlated with the amplitude of the ankle flexion at both speeds (r = -0.59, P = 0.03 and r = -0.60, P = 0.03) and with the electrical activity of the medial gastrocnemius muscle at 3 m s-1 speed (r = -0.62, P = 0.02). Our finding supports the concept that a longer moment arm could be beneficial for distance runners.

The validity and reliability of the Achilles tendon moment arm assessed with dual-energy X-ray absorptiometry, relative to MRI and ultrasound assessments

Dual-energy X-ray absorptiometry (DXA) in single energy mode has been shown to permit the visualisation of bone and soft tissue, such as the patellar tendon through two-dimensional sagittal imaging. However, there is no validated DXA-based measurement of the Achilles tendon moment arm (dAT). The aims of this study were: 1) to compare in vivo DXA derived measurements of the dAT at rest against two previously validated methods: tendon excursion (TE) and magnetic resonance imaging (MRI) at three ankle angles (-5°, 0° and +10°). 2) analyse the intra-day reliability of the DXA method at all ankle angles and compare between methods. Twelve healthy adults (mean ± SD: 31.4 ± 9.5 years; 174.0 ± 9.5 cm; 76.2 ± 16.6 kg) participated in this study, involving test–retest DXA scans, ultrasound scans and one MRI scan. The dAT was defined as the distance from the centre of the calcaneal-tibial joint axis to the Achilles tendon (AT) muscle–tendon line of action. DXA derived dAT measures were significantly greater than MRI measurements (19.7–24.9%) and were 45.2% significantly larger than the TE method. The test–retest reliability of the DXA technique at 0° was high [CV = 1.38%; ICC = 0.96] and despite the consistently larger dAT lengths obtained using DXA, MRI and DEXA data were strongly correlated (r = 0.878, p < 0.001). In conclusion, the DXA technique allowed for highly reproducible in vivo dAT measurement at rest, which has implications for the calculation of AT forces in vivo and the ability to predict the measurement from one tool to the other, thereby providing a novel basis to contrast existing and future studies.

Achilles tendon moment arm changes with total ankle arthroplasty.

Prior research on total ankle arthroplasty (TAA) has focused on improvements in pain and function following the surgical treatment of ankle arthritis, but its effect on ankle joint mechanics has received relatively little attention. The plantarflexion moment arm of the Achilles tendon is a critical determinant of ankle function with the potential to be altered by TAA. Here we investigate the effect of TAA on Achilles tendon moment arm assessed using two methods. Standing sagittal-plane radiographs were obtained for ten patients presurgery and postsurgery, from which anterior-posterior distance between the posterior calcaneus and the center of the talar dome was measured. Ultrasound imaging and three-dimensional (3D) motion capture were used to obtain moment arm pre- and post-TAA. The absolute changes in moment arm pre- to post-TAA were significantly different from zero for both methods (9.6 mm from ultrasound and 4.6% of the calcaneus length from radiographs). Only 46% of the variance in postoperative 3D Achilles tendon moment arm was explained by the preoperative value (r2 = 0.460; p = .031), while pre- and post-TAA values from radiographs were not correlated (r2 = 0.192, p = .206). While we did not find significant mean differences in Achilles tendon moment arm between pre- and post-TAA, we did find absolute changes in 3D moment arm that were significantly different from zero and these changes were partially explained by a change in location of the talar dome as indicated by measurements from radiographs (r2 = 0.497, p = .023).

Effects of Achilles Tendon Moment Arm Length on Insertional Achilles Tendinopathy

Insertional Achilles tendinopathy (IAT) is caused by traction force of the tendon. The effectiveness of the suture bridge technique in correcting it is unknown. We examined the moment arm in patients with IAT before and after surgery using the suture bridge technique, in comparison to that of healthy individuals. We hypothesized that the suture bridge method influences the moment arm length. An IAT group comprising 10 feet belonging to 8 patients requiring surgical treatment for IAT were followed up postoperatively and compared with a control group comprising 15 feet of 15 healthy individuals with no ankle complaints or history of trauma or surgery. The ratio of the moment arm (MA) length/foot length was found to be statistically significant between the control group, the IAT group preoperatively and the IAT group postoperatively (p &lt; 0.01). Despite no significant difference in the force between the control and preoperative IAT groups, a significantly higher force to the Achilles tendon was observed in the IAT group postoperatively compared to the other groups (p &lt; 0.05). This study demonstrates that a long moment arm may be one of the causes of IAT, and the suture bridge technique may reduce the Achilles tendon moment arm.

Achilles tendon moment arms are similar when computed using a single fixed axis versus a moving instantaneous helical axis

Accurate location of the axis of ankle rotation is critical to in vivo estimates of Achilles tendon moment arm. Here we investigated how the plantarflexion moment arm of the Achilles tendon is affected by using an instantaneous helical axis that moves with ankle motion as opposed to a single fixed joint axis that approximates the average axis of rotation. Twenty young healthy adults performed a series of weightbearing cyclical plantar- and dorsi-flexion motions. Motion analysis tracked the motions of markers placed on the foot and shank and also tracked an ultrasound probe imaging the Achilles tendon. Differences in ATma between the methods were investigated using a two-way repeated-measures ANOVA with factors of joint angle (+5°, 0°, −5°, −10°, −15°) and method (instantaneous helical axes, fixed axis). Moment arms computed between the two methods were moderately to strongly correlated, especially in the mid-range of motion (for 0° to 10° plantarflexion, all r2 > 0.619 and all p < 0.004). The two methods produced Achilles tendon moment arms that were comparable and not significantly different except in the most dorsiflexed position, when they differed on average by 9.35 ± 3.23 mm (p = 0.001). Our results suggest that either approach for locating the axis of ankle rotation would be appropriate for the purpose of estimating ATma, but that a fixed axis may be preferable because it is applicable over a greater range of ankle motion.

Shear Wave Tensiometry Reveals an Age-Related Deficit in Triceps Surae Work at Slow and Fast Walking Speeds.

Prior studies have observed an age-related decline in net ankle power and work at faster walking speeds. However, the underlying changes in muscle-tendon behavior are not well-understood, and are challenging to infer from joint level analyses. This study used shear wave tensiometry to investigate the modulation of force and work done by the triceps surae across walking speeds. Fourteen healthy young (7F/7M, 26 ± 5 years) and older (7F/7M, 67 ± 5 years) adults were tested. Subjects walked on an instrumented treadmill at four walking speeds (0.75, 1.00, 1.25, and 1.50 m/s) while lower extremity kinematics and Achilles tendon shear wave speeds were collected. Subject-specific calibrations were used to compute Achilles tendon force from wave speed. Excursions of the soleus and gastrocnemius muscle-tendon units were computed from the kinematic data and subject-specific measures of the Achilles tendon moment arm. Work loop plots were then used to assess effective muscle-tendon stiffness during lengthening, and positive, negative, and net work production during stance. Two-way mixed ANOVAs were used to evaluate the effects of age group and walking speed on each outcome measure. Tendon loading during muscle-tendon lengthening (effective stiffness) did not differ between age groups, but did vary with speed. The soleus became effectively stiffer with increasing speed while the gastrocnemius became effectively more compliant. There was a marked age-related deficit in net soleus (−66% on average) and gastrocnemius (−36%) work across all walking speeds. We did not observe an age-speed interaction effect on net work production. These results suggest the age-related deficit in triceps surae output in walking is pervasive across speed, and hence seemingly not linked to absolute mechanical demands of the task.

Effective Mechanical Advantage About the Ankle Joint and the Effect of Achilles Tendon Curvature During Toe-Walking.

Aim: To study the causes of locomotor dysfunction, estimate muscle forces, or understand the influence of altered sarcomere and muscle properties and behaviours on whole body function, it is necessary to examine the leverage with which contractile forces operate. At the ankle joint, current methods to quantify this leverage for the plantarflexors do not account for curvature of the Achilles tendon, and so may not be appropriate when studying equinus gait. Thus, novel methodologies need to be developed and implemented to quantify the Achilles tendon moment arm length during locomotion.Methods: Plantarflexor internal moment arm length and effective mechanical advantage of 11 typically developed young adults were calculated throughout stance, while heel-toe walking and voluntarily toe-walking on an instrumented treadmill. Achilles tendon moment arm was defined in two-ways: (1) assuming a straight tendon, defined between the gastrocnemius medialis myotendinous junction and Achilles tendon insertion point, and (2) accounting for tendon curvature, by tracking the initial path of the Achilles tendon from the calcaneal insertion.Results: When accounting for tendon curvature, Achilles tendon moment arm length and plantarflexor effective mechanical advantage did not differ between walking conditions (p > 0.05). In contrast, when assuming a straight tendon, Achilles tendon moment arm length (p = 0.043) and plantarflexor effective mechanical advantage (p = 0.007) were significantly greater when voluntary toe-walking than heel-toe walking in late stance.Discussion: Assuming a straight Achilles tendon led to a greater Achilles tendon moment arm length and plantarflexor effective mechanical advantage during late stance, compared to accounting for tendon curvature. Consequently, plantarflexor muscle force would appear smaller when assuming a straight tendon. This could lead to erroneous interpretations of muscular function and fascicle force-length-velocity behaviour in vivo, and potentially inappropriate and ineffective clinical interventions for equinus gait.

Estimates of Achilles tendon moment arm differ when axis of ankle rotation is derived from ankle motion

The plantarflexor moment arm of the Achilles tendon determines the mechanical advantage of the triceps surae and also indirectly affects muscle force generation by setting the amount of muscle-tendon shortening per unit of ankle joint rotation. The Achilles tendon moment arm may be determined geometrically from an axis (or center) of joint rotation and the line of action of the tendon force, but such moment arms may be sensitive to the location of the joint axis. Using motion analysis to track an ultrasound probe overlying the Achilles tendon along with markers on the shank and foot, we measured Achilles tendon moment arm during loaded and unloaded dynamic plantarflexion motions in 15 healthy subjects. Three representations of the axis or center of rotation of the ankle were considered: (1) a functional axis, defined by motions of the foot and shank; (2) a transmalleolar axis; and (3) a transmalleolar midpoint. Moment arms about the functional axis were larger than those found using the transmalleolar axis and transmalleolar midpoint (all p < 0.001). Moment arms computed with the functional axis increased with plantarflexion angle (all p < 0.001), and increased with loading in the most plantarflexed position (p < 0.001) but these patterns were not observed when either using a transmalleolar axis or transmalleolar midpoint. Functional axis moment arms were similar to those estimated previously using magnetic resonance imaging, suggesting that using a functional axis for ultrasound-based geometric estimates of Achilles tendon moment arm is an improvement over landmark-based methods.

Children with cerebral palsy have larger Achilles tendon moment arms than typically developing children

The effectiveness of the plantarflexor muscle group to generate desired plantarflexion moments is modulated by the geometry of the Achilles tendon moment arm (ATMA). Children with cerebral palsy (CP) frequently have reduced plantarflexion function, which is commonly attributed to impaired muscle structure and function, however little attention has been paid to the potential contribution of ATMA geometry. The use of musculoskeletal modelling for the simulation of gait and understanding of gait mechanics, rely on accuracy of ATMA estimates. This study aimed to compare 3D in-vivo estimates of ATMA of adults, children with CP and typically developing (TD) children, as well as compare 3D in-vivo estimates to linearly scaled musculoskeletal model estimates. MRI scans for eight children with CP, 11 TD children and nine healthy adults were used to estimate in-vivo 3D ATMA using a validated method. A lower limb musculoskeletal model was linearly scaled to individual tibia length to provide a scaled ATMA estimate. Normalised in-vivo 3D ATMA for children with CP was 17.2% ± 2.0 tibia length, which was significantly larger than for TD children (15.2% ± 1.2, p = 0.013) and adults (12.5% ± 0.8, p < 0.001). Scaled ATMA estimates from musculoskeletal models significantly underestimated in-vivo estimates for all groups, by up to 34.7%. The results of this study show children with CP have larger normalised 3D ATMA compared to their TD counterparts, which may have implications in understanding reduced plantarflexor function and the efficacy of surgical interventions whose aim is to modify the musculoskeletal geometry of this muscle group.

The effect of foot type on the Achilles tendon moment arm and biomechanics

BackgroundThe aim was to calculate the Achilles tendon moment arm in different degrees of plantarflexion for pes planus, pes cavus and normal arched feet. Methods99 patients (99 radiographs; 40 males, 59 females; mean age 49 years, SD 15) with a healthy ankle joint and a preoperative weightbearing lateral radiograph of the foot were included. Three groups (pes planus, pes cavus and normal-arched feet) with equal sample sizes (n=33) were formed. On radiographs, the angle formed between a horizontal line and the line connecting the insertion of the Achilles tendon with the center of rotation of the ankle, was measured. The interrater reliabilities (ICC) of the angle alpha were compared on radiographs and on MRIs. Using the angle alpha, the Achilles tendon moment arm was calculated in different plantarflexion positions. ResultsThe ICC of alpha was higher on radiographs (0.84, [0.73–0.91]) than on MRIs (0.61, [0.27–0.81]). The average alpha was statistically significantly different (normal arched foot 31 degrees (°), pes planus 24°, pes cavus 36°, p=0.021), resulting in a significant shorter Achilles tendon moment arm for pes cavus than for pes planus (p<0.0001) and normal arched feet (p=0.006) in neutral position. ConclusionThe data suggests that it is feasible to use radiographs to measure the Achilles tendon moment arm. The maximum Achilles tendon moment arm is reached at different angles of ankle flexion for pes cavus, pes planus and normal-arched feet. This has to be taken into consideration when planning surgeries.

The Effect of Three Foot Types on the Achilles Tendon Lever Arm

Category: Hindfoot Introduction/Purpose: During locomotion, propulsion of the body is created by the force of the triceps surae complex as it is transmitted to the metatarsal heads. The amount and pattern of the resulting propulsion force highly depends on the moment arm of the Achilles tendon. To our knowledge, no data exists on how and to which extent position and morphology of the foot affects the moment arm of the Achilles tendon. The aim of this study was 1) to develop a method to determine the Achilles tendon moment arm, and 2) to calculate the Achilles tendon moment arm with the foot in different degrees of dorsi- and plantarflexion for 3 foot types (normal arched foot, pes planus, and pes cavus). Methods: 99 study participants with a healthy ankle joint (males, 40; females, 59; mean age 49 [range, 14 – 78] years) were included. Participants’ foot type was classified as a normal arched foot (n = 33), as pes planus (n = 33), or as pes cavus (n = 33) based on the calcaneal inclination angle (CI) (Figure 1). Besides the foot type, the foot length (FL), the calcaneal insertion of the Achilles tendon (ATI), the angle (a) between the line (L) connecting ATI with the center of rotation of the ankle (COR) and the horizontal line (L’) were measured on the lateral radiographs. The interrater reliabilities of measuring a on radiographs and on MRIs were compared. The lever arm of the Achilles tendon (L’calculated) was calculated as following (foot and tibia were regarded as two rigid segments; the influences of other muscles were neglected): L’calculated = cos(a - plantarflexion)*L Results: The interrater reliability of a was higher on radiographs (ICC = 0.84, [0.73 – 0.91]) than on MRIs (ICC = 0.61, [0.27 – 0.81]). The ICC comparing a measured on MRIs and radiographs was 0.63 [0.50-0.74]. There was no difference in FL between the three foot types (p = 0.199). However, the average a was significantly different (normal arched foot 31°, pes planus 24°, pes cavus 36°, p = 0.021), resulting in a statistically significant shorter Achilles tendon lever arm for pes cavus than for pes planus (p &lt; 0.0001) and normal arched feet (p = 0.006) in neutral position. The maximum lever arm for the three different foot types was reached at different degrees of plantarflexion (Figure 2). Conclusion: The assessment of the Achilles tendon lever arm using radiographs is reliable. The foot configuration determines the lever arm of the Achilles tendon for a given flexion position of the foot. It also determines the plantarflexion position where the Achilles tendon reaches the maximum of its lever arm. This has to be taken into consideration when planning surgeries that change a or L, as they may also result in changes of plantarflexion power.