Assessment of Passive Stiffness of Medial and Lateral Heads of Gastrocnemius Muscle, Achilles Tendon, and Plantar Fascia at Different Ankle and Knee Positions Using the MyotonPRO

The elastic properties of the Achilles tendon (AT) are altered in local injury or other diseases and in response to changes in mechanical load. Recently, elastography has been used to evaluate variations in tendon elastic properties, mainly among healthy individuals or athletes. Therefore, this study evaluated the biomechanical changes in ATs in individuals with and without plantar fasciitis (PF). The purposes were as follows: (1) to evaluate the passive stiffness of three regions of the AT which defined as 0 (AT0 cm), 3 (AT3 cm), and 6 cm (AT6 cm) above the calcaneal tuberosity in participants with and without PF, (2) to investigate the interplay between the passive stiffness in patients with PF and pain, (3) to detect optimal cut-off points of stiffness of the AT in assessing individuals with chronic PF, and (4) to determine the correlation between the plantar fascia thickness (PFT) and pain. This cross-sectional study included 40 participants (mean age = 51 ± 13 years). When the ankle was in a relaxed position, patients with PF experienced increased passive stiffness in AT0 cm (p = 0.006) and AT3 cm (P = 0.003), but not in the neutral position. Significant correlations were observed between pain and stiffness of AT (AT0 cm r = 0.489, P = 0.029; AT3 cm r = 487, P = 0.030; AT6 cm r = 0.471, P = 0.036), but not in the PFT (P = 0.557). Optimal cut-off stiffness was AT (452 kPa) in the relaxed ankle position. The plantar fascia of patients with PF was significantly thicker than that of the controls (P < 0.001). Findings from the present study demonstrate that tendon stiffness is a good indicator of the clinical situation of patients with PF. Monitoring passive tendon stiffness may provide additional information to assess severity of the condition and guide therapeutic. The treatment programs for PF should also be tailored to the distal AT, as conventional therapy might not be targeted to tight tendons.

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AB0501 CORRELATION BETWEEN AXIAL AND PERIPHERAL ENTHESIS IN SPONDYLARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2229 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1278.1-1278

Author(s):

H. Ferjani ◽

M. Yasmine ◽

K. Maatallah ◽

E. Labbene ◽

H. Riahi ◽

...

Keyword(s):

Achilles Tendon ◽

Chest Wall ◽

Age Of Onset ◽

Scoring Systems ◽

Plantar Fascia ◽

Anterior Chest Wall ◽

Controlled Study ◽

Asas Criteria ◽

The Us ◽

The Mean

Background:Enthesitis is the clinical hallmark of spondylarthritis. It refers to the inflammation of joint attach in the bone. Several sites enthesitis may be affected, and a wide variety of scoring systems were available.Objectives:We aimed to determine the prevalence of axial enthesitis in the anterior chest wall (ACW), and its correlation with peripheral sites especially, the Achilles tendon (AT).Methods:We conducted a prospective study including patients with SpA according to the ASAS criteria. Sociodemographic data, as well as disease characteristics, were recorded. The Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) was used to assess clinical entheses (first and seventh costochondral joints, posterior superior iliac spine, anterior superior iliac spine, iliac crest, and Achilles tendon insertion). The presence of enthesitis on the US was then assessed in the right and left sternoclavicular (SCJ), manubriosternal (MSJ) joints, as well as in the AT, using Esaote My Lab 50.Results:The study included 47 patients with SpA: axial (n=26), axial and peripheral (n=21). There was a female predominance (sex ratio: 0.2). The mean age was 42.2 years ± 12.6 [11-70]. The age of onset of the disease was <40 years in 59.6% of cases. Tenderness in entheseal sites was found in 63.8% of patients, especially in the plantar fascia and AT (32.7%, 6%, respectively). The mean MASES score was 2.9 [0-13]. Clinical ACW involvement (29.1%) was at follows: 1st right chondro-sternal joint (CSJ) (19.1%), 1st left CSJ (25.5%), 7th right CSJ (27.7%) and 7th left CSJ (31.9%).US involvement of the ACW was 14.3%. Enthesitis of the AT was found in 70% of cases on US examination. ACW US involvement was correlated neither to the BMI nor to MASES score (p=0.16, p=0.6 respectively). Similarly, there was no correlation between the presence of US ACW enthesitis and clinical nor the US AT enthesitis (p=0.09, p=0.209, respectively).Conclusion:Our study showed that ACW enthesitis is frequent in SpA, especially by US screening. This axial enthesitis, don’t necessarily reflect a simultaneous clinical or US involvement of the peripheral entheses. Further studies are needed to characterize this subtype of SpA.References:[1]Verhoeven F, Guillot X, Godfrin-Valnet M, Prati C, Wendling D. Ultrasonographic evaluation of the anterior chest wall in spondyloarthritis: a prospective and controlled study. J Rheumatol. 2015;42(1):87-92Disclosure of Interests:None declared.

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AB0797 ULTRASONOGRAPHIC ASSESSMENT OF ENTHESEAL INVOLVEMENT IN PSORIATIC ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6535 ◽

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

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Why heel spurs are traction spurs after all

Scientific Reports ◽

10.1038/s41598-021-92664-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Johann Zwirner ◽

Aqeeda Singh ◽

Francesca Templer ◽

Benjamin Ondruschka ◽

Niels Hammer

Keyword(s):

Achilles Tendon ◽

Soft Tissues ◽

Plantar Fascia ◽

Trabecular Architecture ◽

Pathological Findings ◽

Traction Forces ◽

X Ray ◽

Developmental Mechanism ◽

Common Features ◽

Compressive Loads

AbstractIt is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.

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Mechanical properties of tendon and aponeurosis of human gastrocnemius muscle in vivo

Journal of Applied Physiology ◽

10.1152/jappl.2001.90.5.1671 ◽

2001 ◽

Vol 90 (5) ◽

pp. 1671-1678 ◽

Cited By ~ 150

Author(s):

Tadashi Muramatsu ◽

Tetsuro Muraoka ◽

Daisuke Takeshita ◽

Yasuo Kawakami ◽

Yuichi Hirano ◽

...

Keyword(s):

Mechanical Properties ◽

Achilles Tendon ◽

Gastrocnemius Muscle ◽

Plantar Flexion ◽

Medial Gastrocnemius ◽

Significant Difference ◽

Functional Implications ◽

Male Subjects ◽

Maximal Strain

Load-strain characteristics of tendinous tissues (Achilles tendon and aponeurosis) were determined in vivo for human medial gastrocnemius (MG) muscle. Seven male subjects exerted isometric plantar flexion torque while the elongation of tendinous tissues of MG was determined from the tendinous movements by using ultrasonography. The maximal strain of the Achilles tendon and aponeurosis, estimated separately from the elongation data, was 5.1 ± 1.1 and 5.9 ± 1.6%, respectively. There was no significant difference in strain between the Achilles tendon and aponeurosis. In addition, no significant difference in strain was observed between the proximal and distal regions of the aponeurosis. The results indicate that tendinous tissues of the MG are homogenously stretched along their lengths by muscle contraction, which has functional implications for the operation of the human MG muscle-tendon unit in vivo.

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A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia

BioMed Research International ◽

10.1155/2020/5319640 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Genrui Zhu ◽

Zhifeng Wang ◽

Chengjie Yuan ◽

Xiang Geng ◽

Chao Zhang ◽

...

Keyword(s):

Achilles Tendon ◽

Plantar Fascia ◽

Lateral Ankle ◽

Posterior Side ◽

Negative Results ◽

Significant Difference ◽

Positive Rate ◽

Group A ◽

Achilles Tendonitis ◽

Group B

Background. Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. Methods. The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author’s hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. Results. In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P<0.05). Conclusion. There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.

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Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

Translational Sports Medicine ◽

10.1002/tsm2.103 ◽

2019 ◽

Vol 2 (6) ◽

pp. 316-324 ◽

Cited By ~ 5

Author(s):

René B. Svensson ◽

Christian Couppé ◽

Anne‐Sofie Agergaard ◽

Christian Ohrhammar Josefsen ◽

Mikkel Holm Jensen ◽

...

Keyword(s):

Achilles Tendon ◽

Gastrocnemius Muscle ◽

Cross Sectional Area ◽

Sectional Area ◽

Fascicle Length ◽

Cross Sectional ◽

Functional Loss ◽

Muscle Fascicle ◽

Muscle Cross Sectional Area

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The effect of running, strength, and vibration strength training on the mechanical, morphological, and biochemical properties of the Achilles tendon in rats

Journal of Applied Physiology ◽

10.1152/japplphysiol.00767.2006 ◽

2007 ◽

Vol 102 (2) ◽

pp. 564-572 ◽

Cited By ~ 43

Author(s):

Kirsten Legerlotz ◽

Peter Schjerling ◽

Henning Langberg ◽

Gert-Peter Brüggemann ◽

Anja Niehoff

Keyword(s):

Growth Factor ◽

Achilles Tendon ◽

Muscle Mass ◽

Gastrocnemius Muscle ◽

Biochemical Properties ◽

Tissue Growth ◽

Vibration Strength ◽

Mrna Concentration ◽

Collagen Iii ◽

Tendon Adaptation

Compared with muscle or bone, there is a lack of information about the relationship between tendon adaptation and the applied loading characteristic. The purpose of the present study was to analyze the effect of different exercise modes characterized by very distinct loading patterns on the mechanical, morphological, and biochemical properties of the Achilles tendon. Sixty-four female Sprague-Dawley rats were divided into five groups: nonactive age-matched control (AMC; n = 20), voluntary wheel running (RT; n = 20), vibration strength-trained (LVST; n = 12), high-vibration strength-trained (HVST; n = 6), and high strength-trained (HST; n = 6) group. After a 12-wk-long experimental period, the Achilles tendon was tested mechanically and the cross-sectional area, the soleus and gastrocnemius muscle mass, and mRNA concentration of collagen I, collagen III, tissue inhibitor of metalloproteinase-1 (TIMP-1), transforming growth factor-β, connective tissue growth factor, and matrix metalloproteinase-2 was determined. Neither in the LVST nor in the HVST group could any adaptation of the Achilles tendon be detected, although the training had an effect on the gastrocnemius muscle mass in the LVST group ( P < 0.05). In the HST group, the highest creep was found, but the effect was more pronounced compared with the LVST group ( P < 0.05) than with the AMC group. That indicates that this was rather induced by the low muscle mass rather than by training. However, the RT group had a higher TIMP-1 mRNA concentration in the Achilles tendon in contrast to AMC group ( P < 0.05), which suggests that this exercise mode may have an influence on tendon adaptation.

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