scholarly journals The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain

2021 ◽  
Vol 10 (10) ◽  
pp. 2165
Author(s):  
Du-Hwan Kim ◽  
Jae-Hyeong Choi ◽  
Chul-Hyun Park ◽  
Hee-Jin Park ◽  
Kyung-Jae Yoon ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Plantar Fasciitis ◽  
Clinical Status ◽  
Plantar Fascia ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Diagnostic Utility ◽  
Significant Difference ◽  
Tendon Thickness ◽  
Insertional Achilles Tendinopathy

No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups (p = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups (p < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups (p < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.

scholarly journals Outcomes of Operative Management of Insertional Achilles Tendinopathy in the Young vs Elderly

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142092610
Author(s):  
Huai Ming Phen ◽  
Wesley J. Manz ◽  
Danielle Mignemi ◽  
Joel T. Greenshields ◽  
Jason T. Bariteau
Keyword(s):  
Linear Regression ◽  
Wound Infection ◽  
Surgical Management ◽  
Short Form ◽  
Achilles Tendinopathy ◽  
Heel Pain ◽  
Complication Rates ◽  
Sf 36 ◽  
Significant Difference ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a common cause of chronic posterior heel pain. Surgical intervention reproducibly improves patients’ pain and functional status. We hypothesized that patients older than 60 years would have similar improvements in pain and function and low rates of complications after surgery for IAT when compared to a younger cohort. Methods: Retrospective review of adult case series in patients undergoing surgical management of IAT. Patients were stratified into those 60 years and younger and those older than 60 years. Patients with prior or concomitant surgical procedures and revisions were excluded. Visual analog scale (VAS), Short Form–36 Physical Component Summary and Mental Component Summary (SF-36 PCS/MCS) scores, wound infection, and recurrence, defined as a redevelopment of heel pain in the operative extremity within 6 months, were assessed with a minimum follow-up of 12 months. Statistical analysis was performed using linear regression mixed models and χ2 analysis. Thirty-seven patients were enrolled, with 38 operative heels. The younger cohort had an average age of 49.1 (range, 26-60) years. The older group had an average age of 66.8 (range, 61-76) years. Results: VAS and SF-36 PCS scores for the entire cohort significantly improved at 6 and 12 months postoperatively ( P < .001). Postoperative SF-36 MCS scores for the cohort significantly improved only at 12 months ( P < .001). No significant differences between the young and elderly were seen with regard to improvements in VAS and SF-36 PCS/MCS at 6 or 12 months postoperatively. Multiple linear regression models showed no significant difference between age groups and VAS score, SF-36 PCS/MCS, or change in pain scores after controlling for comorbidities. No significant difference in overall complication rates was seen between the 2 groups (4.9% vs 29.4%, P = .104). There was 1 recurrence of heel pain in the younger group and 4 recurrences of pain in the older group (23.5%) at 6 months, of which 2 resolved at 1 year. There was 1 case of a superficial wound infection requiring antibiotics in the older cohort (5.9%). No patients required surgical revision. Conclusion: Surgical management of IAT in an older population produced similar improvements in clinical results when compared to a younger cohort, with no significant increase in postoperative complications. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Effects of Achilles Tendon Moment Arm Length on Insertional Achilles Tendinopathy

2020 ◽  
Vol 10 (19) ◽  
pp. 6631
Author(s):  
Takuma Miyamoto ◽  
Yasushi Shinohara ◽  
Tomohiro Matsui ◽  
Hiroaki Kurokawa ◽  
Akira Taniguchi ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Moment Arm ◽  
Healthy Individuals ◽  
Suture Bridge ◽  
Significant Difference ◽  
The Moment ◽  
Insertional Achilles Tendinopathy ◽  
Suture Bridge Technique

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 < 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 < 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.

Effect of Acupuncture Treatment on Heel Pain Due to Plantar Fasciitis

1998 ◽  
Vol 16 (2) ◽  
pp. 66-68 ◽  
Author(s):  
A Tillu ◽  
S Gupta
Keyword(s):  
Pain Relief ◽  
Plantar Fasciitis ◽  
Acupuncture Treatment ◽  
Trigger Point ◽  
Plantar Fascia ◽  
Heel Pain ◽  
Poor Responders ◽  
Percentage Improvement ◽  
Significant Difference ◽  
History Of

Eighteen patients attending an orthopaedic outpatient clinic with a year or more's history of heel pain due to plantar fasciitis were studied. All had had conservative treatment of physiotherapy and shoe-support without significant pain relief before acupuncture was offered, and thus acted as their own controls for the purposes of the study. The following traditional points were needled: Taixi (KI.3), Kunlun (BL.60) and Sanyinjiao (SP.6). Pain was assessed by a 100mm visual analogue scale (VAS) before treatment was started and after four, weekly sessions of acupuncture treatment. If complete pain relief was not obtained by the initial four-week treatment, a further two, weekly sessions of the above mentioned acupoints, with the addition of trigger point acupuncture in the gastro-soleus and plantar fascia, was carried out and pain assessed. Patients were also assessed with a verbal rating score to indicate the percentage improvement after acupuncture compared to before treatment. The mean duration of heel pain was 25.11 months (SD 10.68). The VAS data obtained at 4 and 6 weeks of acupuncture treatment showed a statistically highly significant improvement compared to the VAS before acupuncture (p < 0.0009 and p < 0.0001 respectively). Using the Mann-Whitney test, there was a statistically significant difference in VAS obtained at 6 weeks, after trigger point acupuncture had been added for poor responders, compared to that obtained after the first 4 weeks of acupuncture treatment (p < 0.047). Our study demonstrates that acupuncture is effective in treating patients with chronic heel pain due to plantar fasciitis and that the addition of trigger point acupuncture in poor or non-responders may be useful.

Detection of Normal Plantar Fascia Thickness in Adults via the Ultrasonographic Method

2015 ◽  
Vol 105 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Kadir Abul ◽  
Devrim Ozer ◽  
Secil Sezgin Sakizlioglu ◽  
Abdul Fettah Buyuk ◽  
Mehmet Akif Kaygusuz
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Plantar Fasciitis ◽  
Plantar Fascia ◽  
Heel Pain ◽  
Common Cause ◽  
Significant Difference ◽  
The Mean ◽  
The Right ◽  
Thickness Measurements

Background Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. Methods We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18–65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. Results The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4–5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5–5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8–4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8–4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8–5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8–5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. Conclusions The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

scholarly journals On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
A. Singh ◽  
J. Zwirner ◽  
F. Templer ◽  
D. Kieser ◽  
S. Klima ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Plantar Fasciitis ◽  
Functional Relationship ◽  
Plantar Fascia ◽  
Heel Pain ◽  
Strong Correlations ◽  
Cross Sectional ◽  
X Ray ◽  
Plantar Heel Pain ◽  
Morphological Relationship

AbstractCurrent treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF’s insertional length (r = 0.80), and between the CSAs of AT’s and PF’s insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

scholarly journals Up to a quarter of patients with certain chronic recalcitrant tendinopathies may have central sensitisation: a prospective cohort of more than 300 patients

2018 ◽  
Vol 13 (3) ◽  
pp. 137-144
Author(s):  
Patrick C Wheeler
Keyword(s):  
Lower Limb ◽  
Plantar Fasciitis ◽  
Pain Syndrome ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Greater Trochanteric Pain Syndrome ◽  
Duration Of Symptoms ◽  
Central Sensitisation ◽  
Clinical Records ◽  
Insertional Achilles Tendinopathy

Introduction: To identify the possible prevalence of ‘central sensitisation’, in patients with chronic recalcitrant lower limb tendinopathy conditions, with the Central Sensitisation Inventory (CSI) questionnaire. Methods: Patients with chronic lower limb tendinopathy conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified from clinical records. As part of routine care, self-reported numerical markers of pain, global function (using the EuroQol-5D (EQ-5D) questionnaire) and the CSI score to investigate the possibility of central sensitisation were completed. Results: A total of 312 suitable patients with chronic lower limb tendinopathy and similar conditions were identified, who had completed a CSI questionnaire. Of these, 108 presented with greater trochanteric pain syndrome, 12 with patella tendinopathy, 33 with non-insertional Achilles tendinopathy, 48 with insertional Achilles tendinopathy and 110 with plantar fasciitis. A total of 66% of the patients were female, the median age was 54.9 years and the median duration of symptoms was 24 months. There was a median CSI score of 25%, with statistically significant differences noted between the different conditions studied. Overall, 20% of patients scored above a threshold of 40% on CSI questionnaire, indicating that central sensitisation was possible. Greater trochanteric pain syndrome and plantar fasciitis had the highest proportions in the conditions studied. Weak correlations were found between CSI and other pain scores studied. Conclusion: The CSI questionnaire may identify up to a quarter of patients with some chronic lower limb tendinopathy and associated conditions as being more likely to have central sensitisation, and these proportions differed between conditions. The clinical significance of this is unclear, but worth further study to see if/how this may relate to treatment outcomes. These are results from a single hospital clinic dealing with patients with chronic tendinopathy, and comparison with a control group is currently lacking. However, on the information presented here, the concept of central sensitisation should be considered in patients being treated for chronic tendinopathy.

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

2021 ◽  
pp. 193864002110336
Author(s):  
LT Thomas J. Kelsey ◽  
LT Kyle W. Mombell ◽  
CDR Todd A. Fellars
Keyword(s):  
Achilles Tendon ◽  
Suture Anchor ◽  
Maximum Load ◽  
Achilles Tendinopathy ◽  
Catastrophic Failure ◽  
Double Row ◽  
Average Load ◽  
Load To Failure ◽  
Insertional Achilles Tendinopathy ◽  
Repair Techniques

Background In the operative treatment of insertional Achilles tendinopathy, the Achilles tendon is often released from its insertion to allow for adequate debridement of pathologic tissue. The use of a double row suture anchor construct has become increasingly favorable among surgeons after Achilles tendon debridement. This study hypothesized that the addition of a Krackow rip stop suture augment to the double row suture anchor construct would increase the repair’s maximum load to failure. A biomechanically stronger repair would potentially decrease the risk of catastrophic failure with early weight-bearing or accidental forced dorsiflexion after operative management for insertional Achilles tendinopathy. Methods Fourteen cadaveric specimens were used to compare the 2 repair techniques. Achilles tendons were debrided and repaired using either a double row suture anchor with and without the additional Krackow rip stop suture augment. The 2 repair techniques were compared using an axial-torsion testing system to measure average load to failure. Results The average load to failure for the double row suture anchor repair alone was 152.00 N. The average load to failure for the tendons with the double row suture anchor with the Krackow rip stop augment was 383.08 N. An independent-samples Mann-Whitney U-test was conducted and the suture anchor plus Krackow augment group had a significantly higher load to failure ( P = .011, Mann-Whitney U = 5.00, n1 = n2 = 7, P < .05, 2-tailed). Conclusion This study confirmed that the addition of a Krakow rip stop augment to the double row suture anchor is able to increase the maximum load to failure when compared to the double row suture anchor alone. These results suggest the potential of this added technique to decrease the risk of catastrophic failure.

The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis

2021 ◽  
pp. 1-6
Author(s):  
Afsaneh Moosaei Saein ◽  
Ziaeddin Safavi-Farokhi ◽  
Atefeh Aminianfar ◽  
Marzieh Mortezanejad
Keyword(s):  
Range Of Motion ◽  
Ankle Joint ◽  
Visual Analog Scale ◽  
Plantar Fasciitis ◽  
Plantar Flexion ◽  
Plantar Fascia ◽  
Trigger Points ◽  
Dry Needling ◽  
Analog Scale ◽  
Significant Difference

Context: Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles. Methods: In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups. Results: There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups. Conclusion: The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles. Level of evidence: Level 1, randomized controlled trial.

scholarly journals The effect of high-intensity versus low-level laser therapy in the management of plantar fasciitis: randomized participant blind controlled trial

2020 ◽  
Vol 34 (8) ◽  
pp. 1072-1082
Author(s):  
Dovile Naruseviciute ◽  
Raimondas Kubilius
Keyword(s):  
Laser Therapy ◽  
Plantar Fasciitis ◽  
Analogue Scale ◽  
Controlled Trial ◽  
Plantar Fascia ◽  
Time Frame ◽  
Low Level Laser Therapy ◽  
Level Laser ◽  
Significant Difference

Objectives: To evaluate and compare the efficacy of high-intensity laser therapy (HILT) and low-level laser therapy (LLLT) for plantar fasciitis. Design: A participant blind randomized controlled trial with parallel group design and an active comparator with follow-up at four weeks. Settings: Outpatient, University hospital. Subjects: Unilateral plantar fasciitis participants ( n = 102) were randomly assigned into two groups. Recruitment period was from January 2017 to April 2019. Interventions: Interventions included eight sessions of laser therapy over three weeks and single session of patient education. The HILT group ( n = 51) received HILT and the LLLT group ( n = 51) received LLLT. Main measures: Primary outcomes: visual analogue scale; secondary outcomes: pressure algometry, sonography of plantar fascia thickness (time frame: baseline to three-week and four-week follow-up) and numeric rating scale (0%–100%) for opinion of participants on effect of treatment (time frame: three weeks). Data presented: mean (SD) or n (%). Results: There was no statistically significant difference between the groups according to visual analogue scale (pain in general reduction in three weeks: 2.57(3.45) vs. 2.88(3.28) cm), pressure algometry (pain threshold difference between healthy and affected heel reduction in three weeks: 1.80(6.39) vs. 1.77(2.85) kg) and sonography measurements (plantar fascia thickness difference between healthy and affected heel reduction in three weeks: 0.19(0.56) vs. 0.30(0.57) mm). There was a statistically significant difference between the groups in participants’ opinion in favor to HILT group (efficacy of treatment better than 50%: 26(51%) vs. 37(73%)). Conclusion: No statistically significant difference between groups was observed.

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