Utility of Ultrasound for Imaging Osteophytes in Patients With Insertional Achilles Tendinopathy

Abstract

Objective To examine 1) the validity of ultrasound imaging to measure osteophytes, and 2) the association between osteophytes and IAT. Design Case-control study Setting Academic medical center Participants 20 persons with chronic unilateral IAT (Age: 58.7 ± 8.3 years, 50% female) and 20 age- and gender-matched controls (Age: 57.4 ± 9.8 years, 50% female) participated in this case-control study. Intervention Not applicable. Main Outcome Measures Symptoms severity was assessed using the Foot and Ankle Ability Measure (FAAM), Victorian Institute of Sport Assessment- Achilles questionnaire (VISA-A), and the Numerical Rating Scale (NRS). Length of osteophytes was measured bilaterally in both groups using ultrasound imaging and additionally on the symptomatic side of the IAT group using radiographs. The intraclass correlation coefficient was used to examine the agreement between ultrasound and radiograph measures. McNemar, Wilcoxon Signed Rank and Fisher’s exact tests were used to compare the frequency and length of osteophytes between sides and groups. Pearson correlation was used to examine the association between osteophyte length and symptom severity. Results There was good agreement (ICC ≥0.75) between ultrasound and radiograph osteophyte measures. There were no statistically significant differences (P>0.05) between sides or groups in the frequency of osteophytes. Osteophytes were larger on the symptomatic side of the IAT group compared to the asymptomatic side (P= 0.01) and controls (P=0.03). There were no associations between osteophyte length and symptom severity. Conclusions Ultrasound imaging is a valid measure of osteophyte length, which is associated with IAT. While a larger osteophyte indicates pathology, it does not indicate more severe IAT symptom severity.

Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion

“…Repeated compression of the Achilles tendon insertion during daily activities could lead to adaptation and/or pathology of the tissue, resulting in a stiffer tissue. This interpretation is supported by several studies demonstrating the presence of cartilage‐like tissue and osteophytes in the location of IAT pathology . Thus, our findings are consistent with the theory that IAT tendon adapts through metaplasia into tissue that can better resist calcaneal impingement.…”

“…ALTERED TENDON STRAINS IN IAT pathology. 8,14,15 Thus, our findings are consistent with the theory that IAT tendon adapts through metaplasia into tissue that can better resist calcaneal impingement. While intervention studies are needed to test this idea, the clinical application of this theory is that a reduction in transverse compressive strain (e.g., avoidance of endrange DF as part of activity modification and exercise education) could help reduce IAT symptoms and the progression of tendon pathology.…”

“…Hence, IAT in the deep region of the tendon could be an adaptation of the Achilles tendon insertion to increased transverse compression. Furthermore, transverse compression‐induced fibrocartilage in IAT tissue may also be an intermediate state prior to formation of bone (either calcium deposits or bone spurs), a prominent feature of IAT . Nevertheless, it remains unknown how IAT alters the pattern of transverse compressive strain in the Achilles tendon, which could more directly inform this clinical theory.…”

Current Concepts Review Update: Insertional Achilles Tendinopathy

“…Nevertheless, insertional Achilles spurs appear to be more common in patients with IAT (65%-80%) 54,104 than people without foot pain (25%-35%). 13,104 Chimenti et al 13 also found that on average the spurs were significantly longer on the symptomatic side (12.9 mm) compared to the asymptomatic side (8.9 mm, P = .01) and controls (3.5 mm, P = .03). Together these findings indicate that the size of the osteophytes, rather than the presence of osteophytes, may be a contributing factor to the development of symptoms in IAT.…”

Quantifying the Dimensions of Achilles Tendon Insertional Area Using Ultrasound Imaging A Validity and Reliability Study

“…It has become the preferable modality for clinicians' screening and a valuable tool for researchers to compare and describe injured structures (14,15). US imaging has been found to be reliable and valid for evaluating Achilles tendon length, thickness, cross-sectional area, and the calcification length in patient with insertional Achilles tendinopathy (16)(17)(18)(19). However, validated and repeatable methods for evaluating the reliability of US imaging to quantify the insertional Achilles tendon size have yet to be established.…”