Insertional Achilles tendinopathy (IAT) is a painful and common disorder that is difficult to treat. Standard physical therapy interventions that work well for other forms of Achilles tendinopathy are only ~50% effective for IAT, and patients who fail physical therapy require surgeries that are expensive, entail long recovery times and often lead to complications. Thus, there is a need to develop novel and effective treatments to improve clinical outcomes for IAT patients. A critical step in this process is to establish a tool or accurately monitoring the efficacy of conservative and non-conservative care. IAT is thought to be caused by compressive stress due to impingement of the tendon on the heel bone as the ankle rotates, and our preliminary studies support this theory. Thus, we hypothesize that tracking compression of the Achilles tendon against the heel as the ankle rotates is a useful tool for assessing the severity of IAT. In preliminary work, we have shown that we can quantify compression of the Achilles tendon onto the heel by analyzing ultrasound images taken while the ankle rotates.
In Aim 1, we propose to apply this technique to test whether the extent of compression in IAT tendons is larger than in healthy tendons.
In Aim 2, we will investigate whether the extent of compression in IAT tendons is associated with tissue-scale structural and mechanical alterations. Finally, in Aim 3 we will test whether self-reported function in IAT patients is better correlated with our ultrasound-based measurements of tendon compression than with standard clinical measures of heel geometry and muscle stiffness, two factors that may contribute to impingement of the Achilles tendon on the heel. The findings of this study will define a critical threshold for damaging compression in the Achilles tendon that will guide novel, targeted strategies designed to reverse IAT. Furthermore, the inexpensive and non- invasive tool established in this proposal will enable longitudinal monitoring of treatments for this IAT tht may help improve outcomes for IAT patients. Project Description Page 1

Public Health Relevance

To improve treatment for Insertional Achilles tendinopathy (IAT), a common and painful disease that resists standard forms of non-operative care, it is critical to develop a technique to accurately and longitudinally monitor this disease and the effects of surgical and non-surgical interventions. Since it is thought that IAT is associated with compression of the Achilles tendon onto the heel bone as the ankle rotates, this study proposes to assess the severity of IAT by using ultrasound elastography to quantify Achilles tendon compression. This inexpensive and non-invasive tool will inform targeted, patient-specific treatments for IAT that may help improve outcomes for IAT patients.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Small Research Grants (R03)
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Special Emphasis Panel (ZAR1-XZ (M1))
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Panagis, James S
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University of Rochester
Biomedical Engineering
Schools of Engineering
United States
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Chimenti, Ruth L; Bucklin, Mary; Kelly, Meghan et al. (2017) Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. J Orthop Res 35:910-915
Bah, Ibrahima; Kwak, Samuel T; Chimenti, Ruth L et al. (2016) Mechanical changes in the Achilles tendon due to insertional Achilles tendinopathy. J Mech Behav Biomed Mater 53:320-328
Chimenti, Ruth L; Chimenti, Peter C; Buckley, Mark R et al. (2016) Utility of Ultrasound for Imaging Osteophytes in Patients With Insertional Achilles Tendinopathy. Arch Phys Med Rehabil 97:1206-9
Chimenti, Ruth L; Flemister, A Samuel; Ketz, John et al. (2016) Ultrasound strain mapping of Achilles tendon compressive strain patterns during dorsiflexion. J Biomech 49:39-44