The Effect of Achilles Tendon Lengthening on Ankle Dorsiflexion: A                     Cadaver Study

Costa, Matthew L.; Logan, Karl; Heylings, David; Donell, Simon; Tucker, Keith

doi:10.1177/107110070602700605

Cited by 49 publications

(42 citation statements)

References 9 publications

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“…Importantly, and as hypothesized, significantly increased Achilles tendon elongation was only seen if the ankle was immobilized at maximal dorsiflexion (20°) for 1 or 3 weeks. Clinical data suggest that Achilles tendon lengthening can be correlated with poor clinical outcomes and enduring changes in ankle dorsiflexion . In our model, even short immobilization (1 week) at 20° led to a significantly longer tendon than did immobilization in full plantarflexion (160°), and this corresponded with diminished propulsion force off the injured limb during ambulation post‐injury.…”

Section: Discussionmentioning

confidence: 64%

“…Clinical data suggest that Achilles tendon lengthening can be correlated with poor clinical outcomes and enduring changes in ankle dorsiflexion. 11,32 In our model, even short immobilization (1 week) at 20˚led to a significantly longer tendon than did immobilization in full plantarflexion (160˚), and this corresponded with diminished propulsion force off the injured limb during ambulation post-injury. This finding suggests that dorsiflexed immobilization, or delayed treatment, may be associated with reduced push-off strength in endrange plantarflexion, mirroring an outcome seen clinically in humans.…”

Section: Discussionmentioning

confidence: 66%

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Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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Conservative (non‐operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end‐to‐end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid‐point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 66%

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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“…Passive forces may also occur in other joint structures (e.g. bone, ligaments, skin), although the Achilles tendon has been found to be the primary structure limiting ankle joint dorsiflexion, and thus is probably the major contributor to passive force within a physiological joint range of motion (Costa et al, 2006). A sensitivity analysis found that any errors in predicting reductions in passive muscle force during MVC will have a small effect on the shape of the F-L curve and the assessment of subjectspecific L 0 ; when the reduction in passive forces is ignored, the estimate of L 0 is altered by less than 1% (Fig.A2B).…”

Section: Influence Of Passive Sol Force On Estimates Of Lmentioning

confidence: 99%

On the ascent: the soleus operating length is conserved to the ascending limb of the force-length curve across gait mechanics in humans

Rubenson

Pires

Loi

et al. 2012

Journal of Experimental Biology

101

110

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SUMMARYThe region over which skeletal muscles operate on their force-length (F-L) relationship is fundamental to the mechanics, control and economy of movement. Yet surprisingly little experimental data exist on normalized length operating ranges of muscle during human gait, or how they are modulated when mechanical demands (such as force output) change. Here we explored the soleus muscle (SOL) operating lengths experimentally in a group of healthy young adults by combining subject-specific F-L relationships with in vivo muscle imaging during gait. We tested whether modulation of operating lengths occurred between walking and running, two gaits that require different levels of force production and different muscle-tendon mechanics, and examined the relationship between optimal fascicle lengths (L 0 ) and normalized operating lengths during these gaits. We found that the mean active muscle lengths reside predominantly on the ascending limbs of the F-L relationship in both gaits (walk, 0.70-0.94 L 0 ; run, 0.65-0.99 L 0 ). Furthermore, the mean normalized muscle length at the time of the peak activation of the muscle was the same between the two gaits (0.88 L 0 ). The active operating lengths were conserved, despite a fundamentally different fascicle strain pattern between walking (stretch-shorten cycle) and running (near continuous shortening). Taken together, these findings indicate that the SOL operating length is highly conserved, despite gait-dependent differences in muscle-tendon dynamics, and appear to be preferentially selected for stable force production compared with optimal force output (although length-dependent force capacity is high when maximal forces are expected to occur). Individuals with shorter L 0 undergo smaller absolute muscle excursions (P<0.05) so that the normalized length changes during walking and running remain independent of L 0 . The correlation between L 0 and absolute length change was not explained on the basis of muscle moment arms or joint excursion, suggesting that regulation of muscle strain may occur via tendon stretch.

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“…The range of ankle dorsiflexion was most influenced by the length of the Achilles tendon 28) . The division of the other tendons and the capsular tissue around the ankle joint did not affect the range of ankle dorsiflexion.…”

Section: Discussionmentioning

confidence: 98%

Comparing Changes in the Calf Muscle during Weight-bearing and Non-weight-bearing Stretching

Kasuyama

Sakamoto

Kato³

2011

J Phys Ther Sci

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Abstract.[Purpose] The aim of this study was to investigate and compare changes in muscle fascicle and tendon tissue behavior during stretching between a weight-bearing position and non-weight-bearing position. [Subjects] The study subjects were fifteen healthy individuals. [Method] Changes in the calf muscle after stretching in a weight-bearing and a non-weight-bearing position were compared using ultrasonography. Weight-bearing and non-weight-bearing stretching were performed for 30 seconds, and the medial gastrocnemius (MG) muscle fascicle length, pennation angle, and Achilles tendon length were measured before and after stretching.[Results] The post-stretching results in both positions showed increased fascicle length, decreased pennation angle, and increased Achilles tendon length compared with the pre-stretching results. Significant interactions were found between weight-bearing and stretching as evidenced by MG fascicle length and Achilles tendon length; specifically, the non-weight-bearing position increased the length more than the weight-bearing position. [Conclusion] This study revealed that while both weight-bearing and non-weight-bearing stretching were able to stretch the MG muscle and the Achilles tendon, non-weightbearing stretching was more effective with regard to extending the MG muscle and Achilles tendon.

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The Effect of Achilles Tendon Lengthening on Ankle Dorsiflexion: A Cadaver Study

Cited by 49 publications

References 9 publications

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

On the ascent: the soleus operating length is conserved to the ascending limb of the force-length curve across gait mechanics in humans

Comparing Changes in the Calf Muscle during Weight-bearing and Non-weight-bearing Stretching

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