Achilles Tendon Width Research Articles

Ultrasonographic Assessment of Normal Achilles Tendon Thickness and Width in the Asymptomatic Sudanese Population

Background: The goal of this study was to measure normal Achilles tendon (AT) thickness and width in adult asymptomatic Sudanese people using high-resolution ultrasound. Methods and Results: The study was conducted on members of a healthy Sudanese population (120 volunteers: 73/60.8% women and 47/39.2% men), who were chosen using simple random sampling. The study cases were all healthy people with no history of AT injuries or abnormalities. All patients were examined using a Toshiba Xairo200 linear transducer with a frequency range of 7-10MHz. All measurements were taken from a transverse scan at the calcaneus bone level of the AT insertion and 2 to 3cm above the calcaneus. The age group 20-27 had the most participants (44.2%), followed by 36-43 years (19.2%), 28-35 years (15.8%), 52-60 years (14.2%), and 44-51 years (6.7%). The study revealed that the mean age of participants was 34.19±12.29 years, height - 164±0.081 cm, weight - 67.22±15.97 kg, and BMI - 24.38±5.84 kg/m2. The mean thickness and width of the AT were 4.36±0.81 mm and 21.85±3.23 mm, respectively, at its insertion into the calcaneus, and 4.63±0.77 mm and 12.20±1.37 mm, respectively, at the level 2-3 cm above the insertion. We found significant differences according to gender between the AT thickness and width at insertion into the calcaneus and above insertion and no statistically significant differences between the AT measurement's right and left side data. Conclusion: The study found gender differences in the AT thickness and width at insertion into the calcaneus and 2-3 cm above the insertion. No statistically significant differences were detected between the AT measurement’s right and left side data.Age, weight, height, and BMI correlated with the thickness and width of the AT at its insertion into the calcaneus and 2-3 cm above. Furthermore, additional research should be conducted using an extended field-of-view technology to measure the length of the AT tendon in the Sudanese population.

Achilles Tendon Thickness Is an Independent Predictor of Carotid Atherosclerosis and Is Associated With a Carotid Plaque Burden.

The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis (r = 0.277; P = .004), cPS (r = 0.225; P = .035), and cTPA (r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study

BackgroundFoot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot’s vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape.MethodsThe shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression.ResultsThe complex nature of a foot’s 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height.ConclusionA detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be obtained from 2D footprints. These insights could be applied in various scientific disciplines, including orthotics and shoe design.

Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon.

Background:Most studies have focused on ill-tendons with a little insight on how intrinsic factors correlate with the Achilles tendon (AT) morphology.Aim:This study aims at establishing how blood pressure (BP), blood glucose (BG), and body mass index (BMI) correlate with the morphology of the AT with emphasis on width changes.Materials and Methods:Participants were volunteers who were recruited during and after an organized health fair by the Medical Students’ body of All Saints University, School of Medicine, Commonwealth of Dominica. A total of 336 people, consisting of 135 males and 201 females volunteered for the study. The most dominant age group was between 60 and 65 years. A self-administered questionnaire was used to acquire necessary information, and a preliminary clinical procedure was used to check for BP, BG, and BMI. Ultrasound examination was done in B-mode using a linear array high-frequency probe with a mediolateral approach at the AT.Results:Among the participants, 42.68%, 69.75%, and 30.38% had normal BP, BG, and BMI readings, respectively. BP, BG, and BMI statistically supported the hypothesis. Individuals with extreme BP, BG, and BMI had their AT width wider when compared with individuals with normal systemic readings. Sonographic examination revealed most participants with normal tendon morphology while some identifiable changes were observed among others.Conclusion:This study suggests that BP, BG, and BMI could affect the morphological integrity of the AT. It indicates that asymptomatic high blood sugar and BP could weaken the AT, leading to pain which may appear unrelated to the physician and patient.

Management of acute Achilles tendon rupture with tendon-bundle technique.

Objective*These authors contributed equally to this work.To explore tendon-bundle technique for treating Achilles tendon rupture with no defects.MethodsPatients with full unilateral Achilles tendon rupture with no defects were included. The Achilles tendon medial edge surgical repair approach was used, revealing horsetail-like rupture bundles. Tendon bundles were anatomically realigned and repaired end-to-end using 5-0 sutures. Patients were followed-up for 1 year, and assessed for differences between the repaired versus healthy limb.ResultsOut of 24 patients (18 male, 6 female; aged 19–56 years) at 1 year following surgery, mean American Orthopaedic Foot and Ankle Society score was 92.4 ± 5.9; mean differences between the surgically repaired versus contralateral side in dorsiflexion and plantarflexion angle were 3.5 ± 2.3° and 5.6 ± 3.2°, respectively; mean difference in calf circumference between the two sides was 0.9 ± 0.5 cm; and mean increase in Achilles tendon width versus the healthy side was 0.8 ± 0.2 cm. By 1 year post-surgery, there were no significant between-side differences in dorsiflexion and plantarflexion angle, or calf circumference.ConclusionsTendon-bundle surgery resulted in good ankle function restoration and low complication rates. Tendon-bundle surgery may reduce blood supply destruction and maximally preserve Achilles tendon length, and may be effective for treating Achilles tendon rupture with no defects.

Effects of physical characteristics, exercise and smoking on morphometry of human Achilles tendon: an ultrasound study

Objectives : The aim of this study was to reveal the normal morphometric values of Achilles tendon using ultrasound (US) imaging in subjects of different gender, age groups, smoking status, and physical exercise habits. Methods: A total of 342 Achilles tendons were examined in the 171 volunteers (69 females, 102 males) with different age, gender, weight, height, smoking and physical exercise habits. Achilles tendon width, length, thickness, cross-sectional area and length were measured using a commercial ultrasound machine with a 9-15 mHz linear-array transducer. Results: The average width, thickness, cross-sectional area and length of the Achilles tendon in male subjects were significantly higher than females. Tendon width, thickness, cross-sectional area and length showed no significant difference between the right and left side. With the exception of the left Achilles tendon thickness, measurements taken for non-smoking subjects were larger than smokers. Achilles tendon measurements of subjects engaged in sportive activities were significantly larger than those with sedentary lifestyle Weight and body mass index were the only anthropometric measurements in correlation with Achilles tendon size. Conclusion: Achilles tendon size varies with age, gender, physical activity and smoking habits. The measurements presented in this study give normal variations of the tendon’s morphologic characteristics, which will be of use in clinical diagnosis. Keywords: Achilles tendon; anthropometry; exercise; smoking; ultrasound

Evaluation of digital and skinfold caliper measurements of the Achilles tendon width

Background: A critical review of the literature shows that very few objective methods for clinically evaluating Achilles tendinopathy have been described. Aim: To evaluate the validity and reliability of common digital and skinfold calipers in measuring the Achilles tendon width. Methods: Reliability study of ten healthy adult volunteers (five males and five females) was performed at the Rheumatology Unit of Barzilai Medical Center, Ashkelon, Israel. Achilles tendon width was measured by ultrasound at two points of both legs (the tendon attachment and 5 cm proximally). Using regular and skinfold calipers, two further measurements were made, three hours apart, at the same sites. Results: Test-retest reliability was high for the skinfold caliper at both the upper (intraclass correlation coefficient (ICC)=0.863, p<0.001) and lower (ICC=0.931, p<0.001) points, and moderate for the regular caliper at upper (ICC=0.730, p<0.001) and lower (ICC=0.641, p<0.001) points. Moderate association was found between ultrasound and caliper measurements at the lower point (Spearman's rank correlation coefficient (rho)=0.721, p=0.019 for regular calipers; rho=0.646, p=0.043 for skinfold calipers). At the upper point, the associations were high (rho=0.778, p=0.008 for regular calipers; rho=0.960, p<0.001 for skinfold calipers). Conclusions: The skinfold caliper showed a higher correlation with ultrasound measurements and higher intraobserver reliability than the regular caliper. Therefore, the skinfold caliper can be recommended in clinics and trials when repeated measurements need to be performed.

AB0798 Association between Knee Osteoarthritis and Achilles Tendinopathy

BackgroundIn our clinical practice, we noticed that individuals with symptomatic knee osteoarthritis (OA) frequently complain on pain or swelling above Achilles tendon. We found no studies that evaluated association between...

AB0786 Knee Osteoarthritis and Functional Changes in Ankle Joint and Achilles Tendon

BackgroundVery few studies studied the relationship between knee OA and ankle joint parameters. Function of ankle joint and gastrocnemius muscle play important role in normal knee functioning, and should be...

Correlating corneal arcus with atherosclerosis in familial hypercholesterolemia.

BackgroundA relationship between corneal arcus and atherosclerosis has long been suspected but is controversial. The homozygous familial hypercholesterolemia patients in this study present a unique opportunity to assess this issue. They have both advanced atherosclerosis and corneal arcus.MethodsThis is a cross-sectional study of 17 patients homozygous for familial hypercholesterolemia presenting to the Clinical Center of the National Institutes of Health. Plasma lipoproteins, circumferential extent of arcus, thoracic aorta and coronary calcific atherosclerosis score, and Achilles tendon width were measured at the National Institutes of Health.ResultsPatients with corneal arcus had higher scores for calcific atherosclerosis (mean 2865 compared to 412), cholesterol-year score (mean 11830 mg-yr/dl compared to 5707 mg-yr/dl), and Achilles tendon width (mean 2.54 cm compared to 1.41 cm) than those without. Corneal arcus and Achilles tendon width were strongly correlated and predictive of each other. Although corneal arcus was correlated with calcific atherosclerosis (r = 0.67; p = 0.004), it was not as highly correlated as was the Achilles tendon width (r = 0.855; p < 0.001).ConclusionCorneal arcus reflects widespread tissue lipid deposition and is correlated with both calcific atherosclerosis and xanthomatosis in these patients. Patients with more severe arcus tend to have more severe calcific atherosclerosis. Corneal arcus is not as good an indicator of calcific atherosclerosis as Achilles tendon thickness, but its presence suggests increased atherosclerosis in these hypercholesterolemic patients.

The reliability of isokinetic testing of the ankle joint and a heel-raise test for endurance

The aim of the present study was to investigate the reliability of different methods used for isokinetic testing of calf muscle strength and endurance. The detailed evaluation of test-retest reliability serves the purpose of establishing reliable research tools when evaluating patients who have sustained an Achilles tendon rupture. The test-retest reliability of isokinetic measurements at the ankle for eccentric and concentric muscle action was calculated in ten healthy male volunteers using intra-class correlation (ICC) and coefficient of variation (CV). Three different positions were compared at the angular velocities of 30 degrees /s and 180 degrees /s for right and left ankles. The ICC for plantar flexion was 0.37-0.95, whilst it was 0.00-0.96 for dorsiflexion. The corresponding CVs were 4.0-19.9 and 2.4-19.8 respectively. The test-retest reliability of standardised heel-raises, Achilles tendon width, calf circumference and ankle range of motion revealed ICC values of 0.71-0.98 and CVs of 0.67-19.1. The test-retest interval was 5 to 7 days. We conclude that all three positions studied for the isokinetic evaluation of calf muscle function are equally reliable concerning plantar flexion at the ankle joint. The same level of reliability was also found in the evaluation of the standing heel-raise test and the isokinetic dorsiflexion test, except for dorsiflexion in the supine position. The reliability of the investigated methods was only fair despite the use of a detailed and standardised test protocol.

Lipoprotein lipase correlates positively and hepatic lipase inversely with calcific atherosclerosis in homozygous familial hypercholesterolemia.

Homozygous familial hypercholesterolemia (FH) is a rare genetic disorder that leads to premature atherosclerosis due to a defective LDL receptor. There is, however, a large degree of phenotypic heterogeneity at the level of atherosclerosis even in patients with identical mutations of the LDL receptor protein. Lipoprotein lipase (LPL) and hepatic lipase (HL) are crucial enzymes in lipoprotein metabolism, and both have been proposed as having proatherogenic as well as antiatherogenic effects. To evaluate a potential role for these enzymes in the severity of atherosclerosis, we correlated postheparin LPL mass and activity as well as HL activity with the volume of total calcific atherosclerosis (heart and thoracic aorta), coronary artery calcific atherosclerosis, and Achilles tendon width as measured by computed tomography in 15 FH homozygotes. LPL dimer and total mass were positively correlated with all three parameters (r = .65 to .87, P < .01) as was LPL activity (r = .52 to .63, P < .05). HL activity was negatively correlated with total and coronary artery calcified lesion volume (r = -.55 to .57, P < .05). In a multiple regression model of the coronary artery lesion volume, LPL dimer mass and HL activity together accounted for 84% of the variability (r = .92, P < .0001). In a multiple regression model of the total calcified lesion volume, HL activity, total cholesterol, age, and LPL dimer mass together accounted for 85% of the variability (r = .92, P = .0005). These data demonstrate a significant correlation of LPL mass and activity with the extent of calcific atherosclerosis in homozygous FH. It is not clear whether LPL is the cause or consequence of the observed correlation, but if the association between LPL and coronary artery lesions is also present in patients with other genetic dyslipoproteinemias, LPL could constitute a new risk factor for cardiovascular disease.

Relation of cholesterol-year score to severity of calcific atherosclerosis and tissue deposition in homozygous familial hypercholesterolemia

The high concentrations of low-density lipoprotein cholesterol in plasma lead to accelerated atherosclerosis in patients homozygous for familial hypercholesterolemia (FH). We addressed the hypothesis that lipid deposition in the arterial vasculahire and in nonvascular tissues in these patients correlates with both the duration and severity of their hypercholesterolemia. The severity of calcific atherosclerosis was defined by calcification scores and a calcified volume determined by electron beam tomography. The extent of tendinous xanthomatosis was quantitated by computed tomography. A cholesterolyear score was calculated based on the age and the yearly mean serum cholesterol concentration of each patient. Seventeen patients homozygous for FH were followed up. The average total cholesterol concentration in the study group was 780 ± 231 mg/dl (20.2 mmol/L), and the cholesterol-year scores ranged from 2,172 mg-year/dl (56 mmol-year/L) to 32,260 mg-year/dl (834 mmol-year/L). Achilles tendon width (r = 0.86) and cross-sectional area (r = 0.81; both p < 0.001) were best correlated with the cholesterol-year score. In addition, the coronary (r = 0.61; p < 0.05), ostial (r = 0.45; p < 0.05), and total (r = 0.77; p < 0.001) calcification atherosclerosis scores all were best correlated with the cholesterol-year score. Calcific atherosclerosis was not observed in these patients until the cholesterol-year score exceeded 10,000 mg-year/dl (260 mmol-year/ L). These findings establish a direct association of cholesterol-year with extravascular lipid deposition in tissues of patients with FH. The cholesterol-year score may be useful in defining the risk of atherosclerosis in patients with more common forms of hypercholesterolemia.