Morphological Characteristics of Passive and Active Structures of the Foot Across Populations With Different Levels of Physical Activity

2021 ◽  
pp. 1-7
Author(s):  
Inmaculada Reina-Martin ◽  
Santiago Navarro-Ledesma ◽  
Ana Belen Ortega-Avila ◽  
Kevin Deschamps ◽  
Alfonso Martinez-Franco ◽  
...  
Keyword(s):  
Physical Activity ◽  
Achilles Tendon ◽  
Patellar Tendon ◽  
Morphological Characteristics ◽  
Plantar Fascia ◽  
Posterior Tibial Tendon ◽  
Cross Sectional ◽  
Posterior Tibial ◽  
Longitudinal Measurement ◽  
The Right

Background: Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. Objective: To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. Design: Cross-sectional and observational. Participants: The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). Results: Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). Conclusion: The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.

Posterior Tibial Tendon Insufficiency: Which Ligaments are Involved?

2005 ◽  
Vol 26 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Jonathan T. Deland ◽  
Richard J. de Asla ◽  
Il-Hoon Sung ◽  
Lauren A. Ernberg ◽  
Hollis G. Potter
Keyword(s):  
Progressive Failure ◽  
Plantar Fascia ◽  
Control Group ◽  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Cross Sectional ◽  
Interosseous Ligament ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Magnetic Resonance Imaging Mri

Background: The pathology manifested in posterior tibial tendon insufficiency (PTTI) is not limited to the posterior tibial tendon. The association of ligament failure with deformity has been discussed in numerous publications, but extensive documentation of the structures involved has not been performed. The purpose of this observational study was to identify the pattern of ligament involvement using standarized, high-resolution magnetic resonance imaging (MRI) in a series of 31 consecutive patients diagnosed with PTTI compared to an age matched control group without PTTI. Method: The structures evaluated by MRI were the posterior tibial tendon, superomedial and inferomedial components of the spring ligament complex, talocalcaneal interosseous ligament, long and short plantar ligaments, plantar fascia, deltoid ligament, plantar naviculocuneiform ligament, and tarsometatarsal ligaments. Structural derangement was graded on a five-part scale (0 to IV) with level 0 being normal and level IV indicating a tear of more than 50% of the cross-sectional area of the ligament. Standard flatfoot measurements taken from preoperative plain standing radiographs were correlated with the MRI grading system. Results: Statistically significant differences in frequency of pathology in the PTTI group and controls were found for the superomedial calcaneonavicular ligament ( p < 0.0001), inferomedial calcaneonavicular ligament ( p < 0.0001), interosseous ligament ( p = 0.0009), anterior component of the superficial deltoid ( p < 0.0001), plantar metatarsal ligaments ( p = 0.0002) and plantar naviculocuneiform ligament ( p = 0.0006). The ligaments with the most severe involvement were the spring ligament complex (superomedial and inferomedial calcaneonavicular ligaments) and the talocalcaneal interosseous ligament. Conclusion: Ligament involvement is extensive in PTTI, and the spring ligament complex is the most frequently affected. Because ligament pathology in PTTI is nearly as common as posterior tibial tendinopathy, treatment should seek to protect or prevent progressive failure of these ligaments.

scholarly journals AB0797 ULTRASONOGRAPHIC ASSESSMENT OF ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1698.2-1699
Author(s):  
I. Mahmoud ◽  
S. Rahmouni ◽  
A. Ben Tekaya ◽  
S. Bouden ◽  
R. Tekaya ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Achilles Tendon ◽  
Patellar Tendon ◽  
Clinical Examination ◽  
Disease Duration ◽  
Plantar Fascia ◽  
Quadriceps Tendon ◽  
The Mean ◽  
Triceps Tendon ◽  
Nail Involvement

Background:Entheseal involvement is a frequent and distinctive feature of psoriatic arthritis (PsA), often under diagnosed. It is especially associated with nail involvement. Because clinical examination is not sensitive enough for the detection of early signs of this involvement, US may be considered as an alternative imaging technique in the diagnosis of enthesopathy.Objectives:The aim of the present study is to evaluate US entheses abnormalities in PsA and their correlation with clinical characteristicsMethods:The study included patients diagnosed with PsA according to the CASPAR criteria. They underwent a thorough clinical examination with special regard to the presence of enthesitis using the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index.The US study bilaterally explored entheses at six sites: proximal plantar fascia, distal Achilles tendon, distal and proximal patellar tendon insertion, distal quadriceps tendon and distal brachial triceps tendon. We evaluated the following elemental lesions of enthesis at each site: thickness and structure of the tendon, calcifications, bursae, erosions, power Doppler signal in bursa or enthesis full tendon.Results:Of the 33 patients, 39.4 % were male. The mean age was 51.2±12.5 years. The mean disease duration was 13.5±10.2 years.The mean DAPSA was 22.8± 19.7 [0.1-84.5]: remission(n=9), low activity (n=5),moderate activity (n=11),high activity(n=8).At inclusion, 11 patients (33.4%) patients presented with psoriatic onychopathy (45 fingernails) with a mean mNAPSI of 14.1±16. Out of the 528 entheseal sites, 92 were tender at the palpation (17,4%) with a mean SPARCC at 2.87.A total of 396 entheseal sites were examined by US. In 140 of them (35.35%), US found at least 1 sign indicative of enthesopathy. The most affected tendon was the distal Achilles tendon (42/396), followed by proximal plantar fascia (32/396), distal patellar tendon (20/396), quadriceps tendon (20/396), distal brachial triceps tendon(14/396) and finally proximal patellar tendon (12/396).The most common elemental lesions were enthsophytes (176), erosions (114) and calcifications (50).We found a positive correlation between age and both calcification (r=0,4, p=0.021) and enthesophytes (r=0.479, p=0.005).We found a positive correlation between enthesophyte and the tender and swollen joints count (r= 0.352, p=0.045, r=0.378, p=0.03) and the SPARCC score (r=0.397, p=0.022).Patients with higher BASDAI had thicker tendons (r=0.355, p=0.05).Patients with nail dystrophy had more bursitis and erosions.US scores did not correlate with sexe, disease duration and disease activity measures (ASDAS, DAPSA, DAS28 and PASI). Patients with subclinical entheseal involvement didn’t have higher inflammatory biomarkers (ESR, CRP).Conclusion:US subclinical enthesopthy are not rare in psoriatic arthritis, in particular in patients with active disease.Clinical nail involvement was associated with bursitis and erosions. New studies including larger study groups are required to verify the findings of the present studyDisclosure of Interests:None declared

Response of the Injured Tendon to Growth Factors in the Presence or Absence of the Paratenon

2018 ◽  
Vol 47 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Sebastian A. Müller ◽  
Nicholas P. Quirk ◽  
Julia A. Müller-Lebschi ◽  
Patricia E. Heisterbach ◽  
Lutz Dürselen ◽  
...  
Keyword(s):  
Growth Factors ◽  
Achilles Tendon ◽  
Platelet Rich Plasma ◽  
Tendon Repair ◽  
Tendon Healing ◽  
Cross Sectional ◽  
Autologous Conditioned Serum ◽  
Injured Tendon ◽  
The Right ◽  
Exogenous Growth Factors

Background: The paratenon is important for Achilles tendon healing. There is much interest in the use of exogenous growth factors (GFs) as potential agents for accelerating the healing of damaged Achilles tendons. Purpose/Hypothesis: The present study used a rat model to study the responses of the injured Achilles tendon to GFs in the presence or absence of the paratenon. The hypothesis was that responses of the injured tendon to GFs would be lower in the absence of a paratenon. Study Design: Controlled laboratory study. Methods: A 4-mm defect was created in the right Achilles tendon of 60 skeletally mature rats, which were treated with a validated combination of GFs (bFGF, BMP-12, and TGF-β1). Animals were randomly assigned to the intact paratenon (IP) group or resected paratenon (RP) group. Healing was studied anatomically, mechanically, and histologically after 1, 2, and 4 weeks. Results: IP tendons showed improved healing compared with RP tendons. IP tendons were significantly stronger (32.2 N and 48.9 N, respectively) than RP tendons (20.1 N and 31.1 N, respectively) after 1 and 2 weeks. IP tendons did not elongate as much as RP tendons and had greater cross-sectional areas (18.0 mm2, 14.4 mm2, and 16.4 mm2, respectively) after 1, 2, and 4 weeks compared with RP tendons (10.5 mm2, 8.4 mm2, and 11.9 mm2, respectively). On histology, earlier collagen deposition and parallel orientation of fibrils were found for IP tendons. Conclusion: The paratenon is essential for efficient Achilles tendon healing. Healing with GFs in this Achilles tendon defect model was superior in the presence of the paratenon. Clinical Relevance: Biological approaches to tendon engineering using GFs are in vogue and have been shown to improve healing of the rat Achilles tendon, most likely by inducing progenitor cells located within the paratenon. Clinically, resection or incision of the paratenon has been proposed for wound closure. Our data demonstrate the fundamental importance of the paratenon, which therefore should be preserved during Achilles tendon repair, especially if augmented with products such as platelet-rich plasma or autologous conditioned serum that are rich in GFs.

Combination of hormone replacement therapy and high physical activity is associated with differences in Achilles tendon size in monozygotic female twin pairs

2009 ◽  
Vol 106 (4) ◽  
pp. 1332-1337 ◽  
Author(s):  
T. Finni ◽  
V. Kovanen ◽  
P. H. A. Ronkainen ◽  
E. Pöllänen ◽  
G. R. Bashford ◽  
...  
Keyword(s):  
Physical Activity ◽  
Hormone Replacement Therapy ◽  
Achilles Tendon ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Physically Active ◽  
Tendon Thickness

Estrogen concentration has been suggested to play a role in tendon abnormalities and injury. In physically active postmenopausal women, hormone replacement therapy (HRT) has been suggested to decrease tendon diameter. We hypothesized that HRT use and physical activity are associated with Achilles tendon size and tissue structure. The study applied cotwin analysis of fourteen 54- to 62-yr-old identical female twin pairs with current discordance for HRT use for an average of 7 yr. Achilles tendon thickness and cross-sectional areas were determined by ultrasonography, and tendon structural organization was analyzed from the images using linear discriminant analysis (LDA). Maximal voluntary and twitch torques from plantar flexor muscles were measured. Serum levels of estradiol, estrone, testosterone, and sex hormone binding globulin were analyzed. Total daily metabolic equivalent score (MET-h/day) was calculated from physical activity questionnaires. Results showed that, in five physically active (MET > 4) pairs, the cotwins receiving HRT had greater estradiol level ( P = 0.043) and smaller tendon cross-sectional area than their sisters (63 vs. 71 mm2, P = 0.043). Among all pairs, Achilles tendon thickness and cross-sectional area did not significantly differ between HRT using and nonusing twin sisters. Intrapair correlation for Achilles tendon thickness was high, despite HRT use discordance ( r = 0.84, P < 0.001). LDA distinguished different tendon structure only from two of six examined twin pairs who had a similar level of physical activity. In conclusion, the effect of HRT on Achilles tendon characteristics independent of genetic confounding may be present only in the presence of sufficient physical activity. In physically active twin pairs, the higher level of estrogen seems to be associated with smaller tendon size.

Strength of Braided Polyblend Polyethylene Sutures versus Braided Polyester Sutures in Achilles Tendon Repair

2010 ◽  
Vol 100 (3) ◽  
pp. 185-188 ◽  
Author(s):  
Keith D. Cook ◽  
Greg Clark ◽  
Eric Lui ◽  
Gaurav Vajaria ◽  
George F. Wallace
Keyword(s):  
Achilles Tendon ◽  
Suture Material ◽  
Tendon Repair ◽  
Contralateral Side ◽  
Suture Technique ◽  
Materials Testing ◽  
Suture Materials ◽  
Cross Sectional ◽  
The Mean ◽  
The Right

Background: Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. Methods: To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond (Ethicon Inc, Somerville, New Jersey) suture materials in Achilles tendon repairs, 12 Achilles tendons were harvested from cadavers aged 18 to 62 years (median age, 42 years). The tendons were transected and repaired using a modified Krackow suture technique. All of the right limbs were repaired with 2-0 FiberLoop, and the contralateral side was repaired with #2 Ethibond. The specimens were mounted to a materials testing system, and the repairs were pulled to failure in an anatomical direction. Results: The mean ± SD yield loads of 2-0 FiberLoop and #2 Ethibond were 233 ± 48 N and 134 ± 34 N, respectively (P = .002). The mean ± SD ultimate load of 2-0 FiberLoop was 282 ± 58 N, and that of #2 Ethibond was 135 ± 33 N (P &lt; .001). The cross-sectional area of one pass of 2-0 FiberLoop was calculated to be 0.21 mm2, and one pass of #2 Ethibond was 0.28 mm2. Conclusions: The smaller-caliber 2-0 FiberLoop was significantly stronger than #2 Ethibond. This study suggests that there is no advantage to using the traditional larger suture material for Achilles tendon repairs; however, further clinical testing is needed to determine the optimal repair technique. (J Am Podiatr Med Assoc 100(3): 185–188, 2010)

scholarly journals Association between the levels of physical activity and plantar pressure in 6-14-year-old children

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8551 ◽  
Author(s):  
Lovro Štefan ◽  
Mario Kasović ◽  
Martin Zvonar
Keyword(s):  
Physical Activity ◽  
Plantar Pressure ◽  
Contact Time ◽  
Cross Sectional Study ◽  
Linear Regression Models ◽  
Older Children ◽  
Cross Sectional ◽  
Time Integral ◽  
Pressure Time ◽  
The Right

Background The main purpose of the study was to determine whether lower levels of physical activity were associated with higher plantar pressure generated under each foot. Methods In this cross-sectional study, we recruited 641 children aged 6–14 years (agemean ± SD = 9.7  ± 2.4 years; heightmean ± SD = 143.6  ± 15.3 cm, weightmean ± SD = 37.6  ± 13.4 kg; body-mass indexmean ± SD = 17.6  ± 3.2 kg/m2; 44.2% girls). We used EMED –XL pressure platform to measure force time integral, pressure-time integral, contact-time and contact area, peak plantar pressure and mean plantar pressure of the right and the left foot during the gait analysis. The level of physical activity was measured by using The Physical Activity Questionnaire for Older Children (PAQ–C). The associations were calculated by using generalized estimating equations with linear regression models. Results Lower levels of physical activity were associated with higher force- and pressure-time integrals, longer contact time and higher peak and mean plantar pressures in both feet. Conclusion Our study shows that the level of physical activity is strongly and inversely associated with plantar pressure in a sample of 6–14 year olds.

scholarly journals Augmentation of ruptured tendon using fresh frozen Achilles tendon allograft in two dogs: a case report

2013 ◽  
Vol 58 (No. 1) ◽  
pp. 50-55
Author(s):  
MR Alam ◽  
WJ Gordon ◽  
SY Heo ◽  
KC Lee ◽  
NS Kim ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Patellar Tendon ◽  
Weight Bearing ◽  
Clinical Signs ◽  
Tibial Tuberosity ◽  
Tendon Allograft ◽  
Fresh Frozen ◽  
The Right ◽  
Suture Failure ◽  
Achilles Tendon Allograft

This article describes two cases of augmentation of ruptured tendon with fresh frozen Achilles tendon allograft (FFATA) in dogs. Case 1 was a two-year-old crossbreed dog (29 kg) that presented with an open wound on the right forelimb and with complete rupture of the flexor carpi ulnaris and superficial digital flexor tendons. Case 2 was a four-year-old crossbreed dog (4 kg) with partial ruptures of the patellar tendon and detachment of the tibial tuberosity in the right hind limb. In both cases, the ends of the ruptured tendon were sutured and apposed after debridement. To minimize suture failure, FFATA (cut to sufficient size) was placed across the primary suture with tension and sutured to the host tendon. In addition, Case 2 received a Krackow suture through a transverse bone tunnel made in the tibia to fix the patellar tendon along with the tibial tuberosity in situ. The surgical areas healed without any evidence of exaggerated inflammatory response or clinical signs consistent with rejection of the allograft. Both the dogs had normal ambulation and weight bearing on the affected limb 12 weeks postoperatively. No postoperative complications were observed during a one-year follow up period except for slight contracture of the carpus and digits of the affected limb in Case 1. Thus, ruptured tendons can be successfully repaired using suture and augmentation with FFCTA. Augmentation with FFATA may provide additional stability, which counters tension on the primary repair and reduces the chance of gap formation or suture failure in case of reconstruction of the damaged tendon in dogs. &nbsp;

Bilateral Posterior Tibial Tendon and Flexor Digitorum Longus Dislocations

2016 ◽  
Vol 10 (2) ◽  
pp. 162-166
Author(s):  
Eric M. Padegimas ◽  
David M. Beck ◽  
David I. Pedowitz
Keyword(s):  
Physical Therapy ◽  
Suture Anchor ◽  
Plantar Flexion ◽  
Posterior Tibial Tendon ◽  
Flexor Digitorum Longus ◽  
Posterior Tibial ◽  
Left Ankle ◽  
The Right ◽  
Flexor Digitorum ◽  
Suture Anchor Repair

The authors present a case of a previously healthy and athletic 17-year-old female who presented with a 3.5-year history of medial left ankle pain after sustaining an inversion injury while playing basketball. Prior to presentation, she had failed prior immobilization and physical therapy for a presumed ankles sprain. Physical examination revealed a dislocated posterior tibial tendon (PTT) that was temporarily reducible, but would spontaneously dislocate immediately after reduction. She had pain and snapping of the PTT with resisted ankle plantar flexion and resisted inversion as well as 4/5 strength in ankle inversion. The diagnosis of dislocated PTT was confirmed on magnetic resonance imaging (MRI). The patient underwent suture anchor repair of the medial retinaculum of the left ankle. At the time of surgery both the PTT and flexor digitorum longus (FDL) were dislocated. Three months postoperatively, the patient represented with PTT dislocation of the right (nonoperative) ankle confirmed by MRI. After failure of immobilization, physical therapy, and oral anti-inflammatory medications, the patient underwent suture anchor repair of the medial retinaculum of the right ankle. At 6 months postoperatively, the patient has 5/5 strength inversion bilaterally, no subluxation of either PTT, and has returned to all activities without limitation. The authors present this unique case of bilateral PTT dislocation and concurrent PTT/FDL dislocation along with review of the literature for PTT dislocation. The authors highlight the common misdaiganosis of this injury and highlight the successful results of surgical intervention. Levels of Evidence: Level V: Case report

Seltene Sehnenpathologien am Fuss

2015 ◽  
Vol 63 (4) ◽  
Keyword(s):  
Conservative Treatment ◽  
Achilles Tendon ◽  
Operative Therapy ◽  
Defect Size ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial

While lesions of the achilles tendon and posterior tibial tendon are common and well known, lesions of other ankle bridging tendons are rare and literature is sparse. However, many of these lesions are equally relevant in terms of maintaining the complex functionality of the foot. Such pathologies include tendinitis, tenosynovitis as well as partial and complete tears. If the continuity of the affected tendon is maintained, conservative treatment is appropriate. In cases of ruptures, operative therapy is often needed. Depending on the defect size and retraction of the tendon, auto- or allograft have to be used.

Sign in / Sign up

Export Citation Format

Share Document