Ultrasonographic Evaluation of the Femoral Cartilage, Achilles Tendon, and Plantar Fascia in Young Women Wearing High-Heeled Shoes

The impact of high-heel shoes on knee joint space width in healthy young females: A real-time ultrasound study

BACKGROUND

Wearing high heel shoes is thought to increase the risk of knee osteoarthritis in females by altering knee joint alignment and increasing muscle activation. However, direct measurements of knee joint space width using ultrasound have been limited. This study aimed to investigate the effects of 8-cm high-heel shoes on knee joint articular space in healthy young females during standing.

METHODS

A cross-sectional study was conducted with 30 healthy females (age 22 ± 1.3 years). Participants' knee medial, lateral and patellofemoral joint space width were measured using an ultrasound imaging device in both barefoot and high-heel shoes conditions. A general linear model was used to compare the impact of high-heel shoes on knee joint articular space with adjusted covariates of demographic and lower limb physical measurement data.

RESULTS

Significant reductions in lateral joint space width were observed in both the dominant and non-dominant knees when wearing high-heel shoes compared with barefoot (mean difference: dominant side = 1.63 ± 3.91 mm, non-dominant side = 2.34 ± 2.65 mm, P = 0.008). No significant changes were detected in medial and patellofemoral joint space width.

CONCLUSION

Wearing 8-cm high-heel shoes significantly reduces the lateral joint space width of the knee in healthy young females during standing, suggesting increased lateral knee joint stress. The current study underscores the importance of including standing as a test component when measuring joint space changes in future studies and clinical practice to comprehensively evaluate the effects of high-heel usage on knee joint biomechanics.

Explaining Variability in the Prevalence of Achilles Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals

OBJECTIVE

To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals.

DESIGN

Systematic review with stratified meta-analysis and meta-regression.

LITERATURE SEARCH

Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020.

STUDY SELECTION CRITERIA

We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions.

DATA SYNTHESIS

Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity.

RESULTS

We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I²>90%, P<.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; P = .015) and participation in physical activity per limb, and mean age of 40 years old or older (P = .022) per participant.

CONCLUSION

There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design. J Orthop Sports Phys Ther 2021;51(5):232-252. Epub 28 Mar 2021. doi:10.2519/jospt.2021.9970.

Ultrasonographic evaluation of the distal femoral and talar cartilage thicknesses in patients with poliomyelitis: a cross-sectional observational study

BACKGROUND

Sequelae of poliomyelitis, coupled with asymmetric impairment and weight-bearing, typically alter walking biomechanics which can be associated with the knee and ankle osteoarthritis.

AIM

We aimed to investigate whether the distal femoral and talar cartilage thicknesses were different in patients with poliomyelitis.

DESIGN

Cross-sectional observational study.

SETTING

Outpatients, tertiary care center.

POPULATION

Thirty-six patients (12 males, 24 females) with a history of poliomyelitis and 36 age, gender and body mass index similar healthy subjects (11 males, 25 females) were enrolled. Mean values for age, body mass index and age of the poliomyelitis onset were 70.2±4.6 years, 27.2±5.7 kg/m2, and 3.6±2.4 years.

METHODS

Visual Analogue Scale (VAS) was used to assess pain. Lower limb muscle strengths were measured by manual muscle testing. The more affected side was identified according to the lower limb manual muscle testing. Bilateral distal femoral cartilage from the lateral femoral condyle, intercondylar area, medial femoral condyle and talar cartilage thicknesses were measured using ultrasound imaging.

RESULTS

Among patients, the onset of poliomyelitis was at 3.6±2.4 years of age, and Functional Ambulation Category scores were 5 (3-5). VAS scores were similar between the sides affected more and less by poliomyelitis. All cartilage thicknesses (except the talar cartilage) of the patients were found to be thinner on the more affected side than the less affected side (all P<0.001). The thickness of talar cartilage was thinner compared to control subjects (P<0.001). Among the patients, quadriceps muscle strength was positively correlated with medial condyle (r=0.377, P=0.024), intercondylar area (r=0.399, P=0.016) and lateral condyle (r=0.363, P=0.030) thicknesses. Knee VAS scores were negatively correlated with talar cartilage thicknesses (r=-0.393, P=0.018).

CONCLUSIONS

We found a thinning of the distal femoral condyle in the more affected paretic sides of poliomyelitis patients as compared to both those of less affected sides and those of healthy controls. Talar cartilages on both sides of the patients were thinner compared to control subjects.

CLINICAL REHABILITATION IMPACT

Our preliminary findings may contribute to the long-term management of patients with long-term poliomyelitis sequelae.

The Transverse Infrapatellar View: A New Ultrasound Technique to Measure Distal Femoral Cartilage Thickness

OBJECTIVES

To examine the reliability and face validity of ultrasound (US) measurements of distal femoral cartilage thickness (CT) using the infrapatellar view (IPV) with knee extension compared to the traditional suprapatellar view (SPV) with knee hyperflexion in young asymptomatic participants and patients with painful knee osteoarthritis (KOA).

METHODS

The IPV was obtained in an extended knee position by placing the US transducer on the patellar tendon at a 60° angle tilted toward the distal femoral condyle in 19 young adults (control group) and 70 patients with KOA. The CT was measured at the medial femoral condyle, the intercondylar notch, and the lateral femoral condyle.

RESULTS

The inter-rater intraclass correlation coefficient was higher for IPV-based CT measurement (range, 0.856-0.858) compared to SPV-based CT measurement (range, 0.315-0.523) among the patients with symptomatic KOA. The IPV-based CT differed significantly between the control group and the KOA group at the intercondylar notch (P < .001) and lateral femoral condyle (P = .006). The SPV-based CT differed significantly between the control group and the KOA group only at the lateral femoral condyle region (P = .014).

CONCLUSIONS

An infrapatellar US evaluation of the distal femoral CT can be a reliable alternative method to a suprapatellar US evaluation for patients with KOA.