Reliability of Achilles Tendon Resting Angle and Calf Circumference measurement techniques

Carmont, Michael R.; Silbernagel, Karin Grävare; Mathy, Alexandre; Mulji, Y.; Karlsson, Jón; Maffulli, Nicola

doi:10.1016/j.fas.2013.06.007

Cited by 66 publications

(69 citation statements)

References 50 publications

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“…The current study found a difference in strain (1.2%) between participants with IAT and controls that was similar in magnitude to that of previous studies comparing participants with midportion Achilles tendinopathy to controls (Arya and Kulig, 5 0.8%; Child et al, 8 1.8%). Methodological differences, such as a passive or active task, 32 range of ankle excursion, 18 and determining the tendon length, 7 can affect values when comparing across studies. For example, it would be anticipated that during an isometric contraction, as performed in the studies of Arya and Kulig 5 and Child et al, 8 the strain would be greater than during a passive task, 32 as performed in the current study.…”

Section: Discussionmentioning

confidence: 99%

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Chimenti¹,

Flemister²,

Tome³

et al. 2014

J Orthop Sports Phys Ther

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A cross-sectional image was obtained 2 cm proximal to the tendon insertion. Echogenicity was quantified as the mean grayscale value for the central 1 cm of the entire depth of the tendon cross-section (FIGURES 1C and 1D). The grayscale value for a pixel could range from 0 (black) to 255 (white). The mean grayscale value for all pixels in the region of interest was quantified using ImageJ, with a lower value indicating greater pathology. All ultrasound images had the same gain setting of 56 and were collected at a 3-cm depth, so that differences in ultrasound settings would not influence the mean grayscale values between participants. Tendon Mechanical PropertiesThe combination of ultrasound imaging and dynamometry was used to measure tendon mechanical properties (strain, stiffness). Each participant's ankle was positioned and secured in a Biodex System 4 (Biodex Medical Systems, Inc, Shirley, NY) in sitting, with the seatback reclined to 45°, the chair height adjusted so that the tibia was parallel to the floor, and the hip in neutral adduction/abduction (FIGURE 2A). The participant's ankle was moved in the sagittal plane from 10° of plantar flexion to 10° of dorsiflexion at a rate of 5°/s, and the passive plantar flexion torque was recorded at a rate of 1000 Hz. Similar to previous studies, 5,8,18 ultrasound imaging was used to track the linear displacement of the gastrocnemius muscle-Achilles tendon junction (MTJ), with the probe at a fixed point on the calf (FIGURES 2B and 2C). A first set of 6 rotations was used for preconditioning, followed by a second set of 6 rotations, from which images were used to calculate tendon mechanical properties. B-mode ultrasound images were collected when the ankle was in (1) 10° of plantar flexion at the start and end of the second set and (2) 10° of dorsiflexion during the third, fourth, and fifth repetitions. The location of the MTJ in each ankle position was averaged, so that distance between the MTJ locations in 10° of plantar flexion and 10° of dorsiflexion could be calculated. A video was taken on the second repetition to confirm that the images captured the full range of MTJ displacement. Passive torque values from the third, fourth, and fifth repetitions of the second set were used for analysis. Participants were instructed to relax as the foot plate moved the ankle. To ensure that the condition was passive, the activity of the medial gastrocnemius and the anterior tibialis muscles was monitored by a 2-channel Bagnoli desktop electromyography system (Delsys Inc, Natick, MA). Single-differential surface electrodes (input impedance greater than 1015 Ω // 0.2 pF; common-mode rejection ratio, -92 dB; noise, 1.2 μV; preamplifier gain, 10 V/V  1%) were used. The contact material was 99.9% Ag, in the shape of 2 bars with contact dimensions of 10 × 1 mm and spaced 1 cm apart. The electrodes were placed over the motor point of the medial gastrocnemius and the anterior tibialis muscles. The raw electromyography signal was viewed using a 2-channel digitizing oscilloscope (Tektr...

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Section: Discussionmentioning

confidence: 99%

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Chimenti¹,

Flemister²,

Tome³

et al. 2014

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

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“…Although these reports show that edema in the lower extremities could increase calf circumference, participants in these studies were younger and healthier than those in the current study. One study reported that ankle joint angle is concordant with calf circumference in assessing for muscle mass, with a standardized error of 0.5–0.6 cm . Considering the size, the measurement error of calf circumference would be assumed to be <1.0 cm.…”

Section: Discussionmentioning

confidence: 99%

“…One study reported that ankle joint angle is concordant with calf circumference in assessing for muscle mass, with a standardized error of 0.5-0.6 cm. 26 Considering the size, the measurement error of calf circumference would be assumed to be <1.0 cm. The increase in calf circumference in the current study is much greater than the measurement error; therefore, the increase might be considered to have been induced by edema.…”

Section: Discussionmentioning

confidence: 99%

Impact of edema on length of calf circumference in older adults

Ishida

Maeda

Nonogaki

et al. 2019

Geriatrics Gerontology Int

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Aim Calf circumference, which is a known simple indicator of muscle mass, increases during edema. However, the extent to which edema increases calf circumference in older adults is unclear. Methods This retrospective cross‐sectional study included patients aged ≥65 years whose nutritional status was assessed by nutrition support teams. Two different types of matching models in each sex were created according to the presence of edema on the right lower limb. All models were adjusted by age, body height, handgrip strength and performance status. Sarcopenia was diagnosed based on both reduced calf circumference and decline of handgrip strength. The prevalence of sarcopenia was estimated before and after adjustment for increment of calf circumference. Results In total, 2101 patients were included. Multifactor matching models showed that the mean difference in calf circumference between pairs was 1.6 cm (95% confidence interval [CI] 1.1–2.1, P < 0.001) for women and 2.1 cm (95% CI 1.6–2.7, P < 0.001) for men. The propensity score matching model similarly showed a mean difference of 1.6 cm (95% CI 1.1–2.1, P < 0.001) for women and 2.0 cm (95% CI 1.5–2.6, P < 0.001) for men. The prevalence of sarcopenia before and after adjusting for an edema‐related increase in calf circumference was 42.6%/48.6% for women and 35.3%/38.5%–38.7% for men. Conclusions Edema in the lower limb increased the calf circumference by approximately 2 cm. When using calf circumference to assess muscle mass in patients with edema, the increase in circumference should be subtracted from the baseline circumference for an accurate assessment. Geriatr Gerontol Int 2019; 19: 993–998.

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“…Therefore, patients might not register impairments leading to decreased physical capabilities, and a high ATRS might be due to low demands of the tendon and not a well-functioning tendon. Following this argument, a physical endurance test like the heel-rise work test [35] or a measurement of tendon length [28, 29] might constitute better primary endpoints. However, these measurements are very specific and do not describe the tendon’s actual capability to function in everyday life.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture: study protocol for a randomized controlled trial

Barfod

Hansen

Hölmich

et al. 2016

Trials

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BackgroundEarly controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affects functional and patient-reported outcomes.Methods/designThe study is performed as a blinded, randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients aged from 18 to 70 years are eligible for inclusion. The intervention group performs early controlled motion of the ankle in weeks 3–8 after rupture. The control group is immobilized. In total, 130 patients will be included from one big orthopedic center over a period of 2½ years. The primary outcome is the patient-reported Achilles tendon Total Rupture Score evaluated at 12 months post-injury. Secondary outcome measures are the heel-rise work test, Achilles tendon elongation, and the rate of re-rupture. The primary analysis will be conducted as intention-to-treat analyses.DiscussionThis trial is the first to investigate the safety and efficacy of early controlled motion in the treatment of acute Achilles tendon rupture in a randomized setup. The study uses the patient-reported outcome measure, the Achilles tendon Total Rupture Score, as the primary endpoint, as it is believed to be the best surrogate measure for the tendon’s actual capability to function in everyday life.Trial registrationClinicalTrials.gov: NCT02015364. Registered on 13 December 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1697-2) contains supplementary material, which is available to authorized users.

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Reliability of Achilles Tendon Resting Angle and Calf Circumference measurement techniques

Cited by 66 publications

References 50 publications

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Impact of edema on length of calf circumference in older adults

Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture: study protocol for a randomized controlled trial

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