Tracking Achilles Tendon Compression to Monitor Insertional Achilles Tendonopathy

 描述(申请人提供)：附着性跟腱病变(IAT)是一种疼痛和常见的疾病，很难治疗。对其他形式的跟腱病变有效的标准物理治疗干预措施对IAT的有效率只有~50%，而未能通过物理治疗的患者需要进行昂贵的手术，恢复时间长，而且往往会导致并发症。因此，有必要开发新的有效的治疗方法来改善IAT患者的临床结果。这一过程中的一个关键步骤是建立一个工具或准确地监测保守和非保守护理的效果。IAT被认为是由于踝关节旋转时肌腱撞击足跟骨造成的压应力所致，我们的初步研究支持这一理论。因此，我们假设，在踝关节旋转时跟踪跟腱对脚跟的压缩是评估IAT严重程度的有用工具。在初步工作中，我们已经证明，我们可以通过分析脚踝旋转时拍摄的超声图像来量化跟腱对脚跟的压迫。在目标1中，我们建议应用这项技术来测试IAT肌腱的压缩程度是否大于健康肌腱。在目标2中，我们将调查IAT肌腱的压缩程度是否与组织尺度的结构和机械改变有关。最后，在目标3中，我们将测试IAT患者的自我报告功能与我们基于超声的肌腱压缩测量是否比与脚跟几何形状和肌肉僵硬的标准临床测量更相关，这两个因素可能导致跟腱撞击脚跟。这项研究的结果将为跟腱的破坏性压迫确定一个关键的阈值，这将指导旨在逆转IAT的新的、有针对性的策略。此外，该提案中建立的廉价和非侵入性工具将使对这种IAT的治疗进行纵向监测可能有助于改善IAT患者的预后。项目说明第1页

 DESCRIPTION (provided by applicant): 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