Noninsertional Achilles Tendinopathy Pathologic Background and Clinical Examination

Ultrasonographic insights into the complex anatomy and biomechanical dynamics of the Achilles tendon and its fascicles: a pictorial essay

This pictorial essay clarifies the complex anatomical and ultrasonographic features of the Achilles tendon. Utilizing high-frequency ultrasound probes (12-18 MHz), the study visualizes the tripartite segmentation of the tendon as it relates to anatomical fascicles. Notably, there is variability in the ultrasound visibility of fascicles and this partition influences biomechanical properties and susceptibility to injury. This essay not only enhances the understanding of Achilles tendon anatomy but also underscores the importance of anatomical knowledge for comprehending associated pathologies. The findings suggest potential areas for further research into tendon pathology, facilitating the development of targeted rehabilitation strategies.

Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review

Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18-65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson's protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric-concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT.

Update on Fibrocartilaginous Disease Clinical Examination

This article provides an update on fibrocartilaginous disease clinical examination. Lesser metatarsophalangeal joint instability is a challenging entity for the foot and ankle surgeon. A correct diagnosis is crucial to instill an appropriate treatment plan that will result in a successful outcome and a satisfied patient. Insertional Achilles tendon disorders are common among active and inactive patients. There is also a high predilection for Achilles tendon pathology among athletes. In this article demographics and patient history, causative factors, differential diagnosis, physical examination, clinical tests, and radiographic evaluation are discussed for plantar plate disorders and insertional Achilles disorders.

Cross-cultural adaptation and measurement properties of the VISA-A questionnaire for Chinese patients with Achilles Tendinopathy

OBJECTIVE

To culturally adapt the VISA-A into a simplified Chinese version (VISA-A-CHN) and test its measurement properties.

DESIGN

Methodological study; SETTING: Hospital and university laboratory.

PARTICIPANTS

240 subjects were divided into the healthy (n = 80), at-risk (n = 80), and tendinopathy groups (n = 80).

MAIN OUTCOMES MEASURES

The internal consistency, test-retest reliability, construct validity, and the floor and ceiling effect of the VISA-A-CHN.

RESULTS

The VISA-A-CHN showed adequate internal consistency (Cronbach's α = 0.73, 95% CI 0.63 to 0.81), excellent test-retest reliability (ICC_3A,1 = 0.97, 95%CI = 0.95 to 0.98), standard error of measurement of 2.2 points, minimum detectable change of 6.0 points, with no floor and ceiling effects. Two factors (pain/symptoms and physical function/activity) were extracted in exploratory factor analysis. There were moderate associations of VISA-A-CHN score with scores of Lower Extremity Functional Scale and SF-36 physical components (r_s = 0.53-0.74, P < 0.01) but low associations with SF-36 mental components (r_s = 0.12-0.22, P > 0.05). VISA-A-CHN mean score of Achilles tendinopathy group was significantly lower than those of healthy and at-risk groups (P < 0.01).

CONCLUSIONS

The VISA-A-CHN is equivalent to the original version in terms of language and measurement properties. It can be used as the outcome measure for Chinese patients with Achilles tendinopathy.

The clinical diagnosis of Achilles tendinopathy: a scoping review

BACKGROUND

Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains.

METHODOLOGY

A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures.

RESULTS

A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured.

CONCLUSIONS

There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.

MRI of the Achilles tendon - a comprehensive pictorial review. Part two

•

The abnormalities on MRI should be correlated with the clinical findings.

•

Higher signal of the Achilles tendon is a common postoperative finding.

•

The fluid signal within the Achilles tendon graft indicates a rupture.

•

Postoperative complications of Haglund’s syndrome should be assessed on MRI.

•

Elongation of the Achilles tendon is seen after surgical or conservative treatment.

The most common disorder affecting the Achilles tendon is midportion tendinopathy. A focal fluid signal indicates microtears, which may progress to partial and complete rupture. Assessment of Achilles tendon healing should be based on tendon morphology and tension rather than structural signal. After nonoperative management or surgical repair of the Achilles tendon, areas of fluid signal is pathologic because it indicates re-rupture. A higher signal in the postoperative Achilles tendon is a common finding and is present for a prolonged period following surgical intervention and needs to be interpreted alongside the clinical appearance.

[Research progress in Achilles tendinopathy]

OBJECTIVE

To explore the classification, diagnosis, and clinical treatment of Achilles tendinopathy.

METHODS

The literature about Achilles tendinopathy at home and abroad was reviewed. The research results of classification and terms, imaging diagnosis, and clinical treatment of Achilles tendinopathy were summarized.

RESULTS

The classification and name of Achilles tendinopathy are not completely unified, and the concept is vague, the cause of disease is not clear. There are many treatment plans, but there is no effective evidence-based medicine research.

CONCLUSION

The diagnosis and treatment of Achilles tendinopathy is complicated. According to the characteristics of Achilles tendon anatomy and etiology, the classification and definition of Achilles tendinopathy need to be further studied in order to guide clinical treatment more effectively and facilitate experience exchange and learning.