Search Results (112)

Background: The progression of orthopedic diseases such as rheumatism and tendinopathies can be affected by metabolic conditions. Recent research suggests that changes in nutrition may affect symptom severity and recovery in orthopedic diseases. This study aims to explore whether the therapeutic efficacy of exercise therapy can be enhanced by adding nutritional advice in Achilles tendinopathy. Method: This 12-week randomized controlled pilot trial enrolled 16 adult patients (age 39.38 ± 9.46 years) suffering from chronic Achilles tendinopathy (≥3 months of symptoms, Victorian Institute of Sport Assessment—Achilles (VISA-A) scores below 80). Participants were randomly assigned to either the experimental group, receiving nutritional advice combined with home-based high-load tendon exercise training, or the control group, receiving exercise training alone. Outcomes included VISA-A scores, visual analog scale (VAS) pain assessments, body composition, and blood markers, analyzed through both intention-to-treat and per-protocol approaches. Results: Baseline characteristics showed no significant intergroup differences. From pre to post VISA-A scores increased from 58.06 ± 12.06 to 74.51 ± 17.81 points (p = 0.005) and VAS decreased from 3.19 ± 2.32 to 1.55 ± 1.66 points (p = 0.048) across all participants. Within-group analysis demonstrated a significant VISA-A improvement (63.13 ± 10.08 to 81.39 ± 13.13 points) (p = 0.013) in the experimental group only. The control group experienced a significant increase of 6.74 ± 12.26 mmHg in diastolic blood pressure (p = 0.046). Conclusions: The exercise intervention improved functional and pain outcomes in all participants, with better VISA-A outcomes in the experimental group. However, a clearly superior effect of the combined strategy compared with exercise alone could not be detected in this pilot study with a limited sample size. Full article

Background: Plantar pressure analysis provides insight into load distribution at the foot–pedal interface during cycling; however, its modulation by pedaling power, cadence, and overuse injury status remains poorly understood by professional cyclists. It is unclear whether common overuse injuries, such as Achilles tendinopathy, patellofemoral pathology, and iliotibial band syndrome, are associated with distinct plantar loading patterns. This study aimed to characterize plantar pressure distribution in elite cyclists and determine how power, cadence, and injury status influence this pattern. Methods: Professional cyclists completed a single integrated protocol using a high-resolution in-shoe pressure system. Plantar forces were recorded across nine anatomical regions and grouped into the transverse and longitudinal segments of the foot. Three phases were included: absolute power manipulation (100 and 200 W), cadence manipulation (80 and 100 rpm) at fixed power, and an ecological combined protocol using relative power (1.5 and 3 W·kg⁻¹) with individualized cadence. The cyclists used their habitual bike setups. Participants were classified into the non-pathological (NP), AT, PFP, or ITBS groups. Mixed repeated-measures ANOVAs were used to analyze the effects of power, cadence, zone, foot, and injury status. Results: The plantar pressure distribution was consistently dominated by the medial forefoot. Increasing the absolute power from 100 to 200 W increased the maximal plantar pressures by 84.74% (p < 0.001), whereas increasing the cadence from 80 to 100 rpm at a fixed power increased the pressures by 15.90% (p = 0.003). Under individualized conditions, increasing relative power from 1.5 to 3 W·kg⁻¹ increased pressures by 39.59% (p < 0.001), whereas cadence had no global main effect but significantly altered the regional pressure distribution (p < 0.001). Injury groups showed pathology-specific deviations, including higher overall pressures and asymmetry in Achilles tendinopathy, bilateral asymmetry in patellofemoral pathology, and asymmetric loading patterns in iliotibial band syndrome. Conclusions: Power is the main determinant of plantar pressure, and cadence modulates load distribution. Overuse injuries induce pathology-specific pressure patterns, supporting plantar pressure analysis for injury prevention and performance optimization in athletes. Full article

Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher’s exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT. Full article

Background/Objectives: The Achilles tendon enthesis (ATE) is a key load-transmitting structure that is frequently affected in musculoskeletal disorders, including insertional tendinopathy, overuse injuries and inflammatory enthesopathies. Reliable non-invasive assessment of the enthesis structure is therefore of increasing clinical importance. This study evaluated the ability of advanced magnetic resonance (MR) microscopy to depict the ultrastructural organization of the ATE using histology as a reference standard. Methods: Five human ATEs from anatomical body donations were included. Two specimens were used for protocol development of the histological preparation, whereas three specimens underwent the full multimodal pipeline comprising undecalcified methyl methacrylate (MMA) thin-section histology with Giemsa staining, T2*-weighted 3D-variable echo time (vTE) MR microscopy at 7 Tesla, and microradiography. Results: Histological analysis demonstrated excellent preservation of fibrocartilage zones and mineralized interfaces. Corresponding MR microscopy data allowed the identification of major structural components of the enthesis, particularly mineralized regions, although fine ultrastructural details remained beyond the MR microscopy resolution. Microradiography supported interpretation of the mineralized tissue architecture and MR microscopy signal characteristics. Conclusions: These findings indicate that high-field MR microscopy can capture clinically relevant structural features of the Achilles tendon enthesis, while histology remains essential for detailed ultrastructural validation. The combined imaging approach provides a translational framework that may support improved diagnosis, monitoring and treatment evaluation in musculoskeletal disorders involving the osteotendinous junction. Full article

Background/Objectives: Platelet-rich plasma (PRP) has become a therapeutic option for tendinopathies. Its clinical efficacy depends on several factors, including the target tendon. The aim of this study was to evaluate the PRP efficacy for tendinopathies in the rotator cuff (RC), Achilles tendon (AT), and patellar tendon (PT). Methods: We conducted a prospective cohort study including patients with RC, AT and PT tendinopathies. Each patient received three multitarget PRP (intratendinous and peritendinous) treatments at intervals of two weeks. Clinical outcomes were assessed at baseline and 6 months using tendon-specific scores (DASH for RC, VISA-A for AT and VISA-P for PT). Responders were identified based on the Minimal Clinically Important Improvement (MCII). Comparative statistical tests and multivariate regression were performed for the analysis. Results: A total of 49 patients were included (RC: 15, AT: 18, PT: 16). The number of responders at 6 months was 33 (67.4%), with 11 (73.3%) in the RC Group, 14 (75.0%) in the AT Group and 8 (50.0%) in the PT Group. The RC and AT patients experienced a significant improvement according to their scores (p < 0.001), which was not seen in the PT group (p = 0.065). The percentage of responders was higher in women (12/13, 92.3%) than men (21/36, 58.3%) (p = 0.025). Conclusions: Repeated intratendinous and peritendinous PRP injections in RC, AT, and PT tendinopathy improved joint-related function six months after treatment. This improvement was less pronounced in patients with PT and the proportion of responders was higher among women. Full article

Macrophages and other phagocytic cells are central regulators of tendon immunobiology, orchestrating inflammation, tissue repair, and extracellular matrix (ECM) remodeling in the tendons. They derive from circulating monocytes and resident tendon-specific populations, including tenophages. Macrophage polarization along the M1/M2 axis exerts a decisive influence on tendon healing trajectories. Activated M1 macrophages promote the early healing phase for debris clearance initiating the reparative cascade. However, their sustained activity leads to inflammation, ECM degradation, impaired healing, tendinopathy, and heterotopic ossification (HO). Conversely, a timed shift toward activated M2 macrophages promotes resolution of inflammation, angiogenesis, ECM deposition, and fibrocartilage formation, whereas excessive or prolonged M2 activity facilitates adhesion formation, fibrosis, scarring and HO. Recent single-cell and spatial profiling studies showed macrophage heterogeneity across tendon compartments, thereby extending the classical M1/M2 paradigm and underscoring the relevance of macrophages/resident tendon cell’s interaction in tendon-specific local niches. Mechanobiological stimuli (depending on magnitude, frequency and duration) further modulate macrophage phenotypes and tendon healing. Emerging coculture models and human tendon-on-chip systems provide high-resolution platforms for dissecting these spatiotemporal interactions. Promising therapeutic approaches comprise the application of extracellular vesicles, controlled mechanoloading regimens, and immunomodulatory biomaterials demonstrating potential to induce regenerative macrophage signatures for improved healing outcomes. Notably, platelet-rich plasma (PRP) formulations shape macrophage responses: leukocyte-rich PRP preferentially promotes M1 activity whereas leukocyte-poor PRP supports M2 polarization. Thus, mechano- and immunomodulatory strategies can offer precise control over macrophage dynamics. Regarding the Achilles tendon pathologies, such approaches are helpful by directing macrophage-mediated inflammation towards effective tendon healing outcomes. Full article

Heel pain is a very common foot condition. Mechanical factors are the most common cause of heel pain. The main causes of heel pain include plantar fasciitis, heel spurs, Achilles tendinopathy, heel neuritis, and heel bursitis. This case study aimed to manage pain in a patient with heel pain accompanied by pronounced pes planus. A 42-year-old woman presented with heel pain and pes planus. The pain was present in the normal standing position and at rest. After examination, a spur, plantar fasciitis, and Morton’s neuroma were diagnosed. The patient, who had not responded to medical and rehabilitative treatments, was evaluated using the visual analog scale and the 36-Item Short Form Survey quality of life questionnaire to assess pain during rest and walking using a newly developed combined exercise method. Significant improvements were observed in the final measurements. This study contributes significantly to our knowledge of the best physiotherapy treatments for patients with heel pain associated with spurs and plantar fasciitis. Full article

Background/Objectives: Insertional Achilles tendinopathy (IAT) is frequently associated with posterior calcaneal spurs; however, the prognostic significance of spur morphology for patient-centered treatment outcomes remains unquantified. This study aimed to establish treatment-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds after extracorporeal shockwave therapy (ESWT) and to determine whether quantitative spur morphology independently predicts achievement of these patient-centered endpoints. Methods: In this retrospective cohort study, 201 patients with IAT and radiographically confirmed posterior calcaneal spurs received standardized ESWT (three weekly sessions, 0.20 mJ/mm², 8 Hz). Spur length and angle were measured on calibrated weight-bearing lateral radiographs. MCID and PASS thresholds for VISA-A, AOFAS, and VAS scores were determined using anchor-based receiver operating characteristic (ROC) analyses. Optimal spur morphology thresholds were derived from ROC curves using PASS achievement as the outcome criterion and the Youden index for cut-off selection. Multivariable logistic regression analyses, adjusted for age, sex, and body mass index, were performed to assess the independent prognostic value of spur morphology. Results: MCID thresholds were: ΔVISA-A ≥ 16.5 (AUC = 0.886), ΔAOFAS ≥ 11.5 (AUC = 0.830), and ΔVAS ≥ 2.5 (AUC = 0.897). PASS thresholds were: VISA-A ≥ 70.5 (AUC = 0.712), AOFAS ≥ 72.5 (AUC = 0.842), and VAS ≤ 3.5 (AUC = 0.753). While significant mean improvements occurred (all p < 0.001), only 36.8–43.3% of patients achieved MCID and 38.3–53.2% achieved PASS. ROC analysis identified spur length > 8.7 mm (AUC = 0.713) and spur angle > 16° (AUC = 0.738) as optimal thresholds predictive of PASS failure. In multivariable analysis, increased spur length (adjusted OR = 0.23–0.24, p < 0.001) and angle (adjusted OR = 0.16–0.23, p < 0.001) independently reduced the likelihood of achieving both MCID and PASS. Conclusions: This study provides the first anchor-based MCID and PASS thresholds for ESWT in IAT and demonstrates that posterior calcaneal spur morphology—specifically length > 8.7 mm and angle > 16°—independently predicts patient-defined treatment success. These findings support the integration of quantitative spur assessment into clinical decision-making for personalized management of IAT. Full article

Background/Objective: Achilles tendinopathy (AT) is a disabling condition, and treatment options are limited in patients in whom corticosteroid injections are discouraged or contraindicated, including individuals with diabetes. Porcine collagen injections have been proposed as a conservative option; however, clinical evidence in diabetic populations remains limited. This study aims to describe pain and functional outcomes after peritendinous collagen injections in diabetic patients with chronic Achilles tendinopathy. Methods: Twenty-two diabetic patients with ultrasound-confirmed degenerative Achilles tendinopathy refractory to conservative management were retrospectively included and split into two groups according to AT type: insertional (IAT) and non-insertional/midportion (NIAT). All patients received five weekly ultrasound-guided peritendinous collagen injections. Outcomes included VAS assessed at baseline, after the second injection, at 1 month, and at 6 months; VISA-A at baseline and 6 months; return-to-work (RTW) time; and adverse events. Baseline variables included BMI, HbA1c, symptom duration, and previous treatments. Analyses were based on descriptive statistics and within-group comparisons over time. Results: All patients completed the treatment protocol, and no adverse events were recorded. Pain significantly improved over follow-up in both subgroups. Mean VAS decreased from baseline to 6 months (mean ΔVAS: 5.1 in IAT and 4.4 in NIAT; p = 0.001 for within-group change). VISA-A also improved at 6 months (mean ΔVISA-A: 32.78 in IAT and 38.97 in NIAT; p < 0.0001). Median RTW was 37 days in IAT and 35 days in NIAT (p > 0.05). No significant between-group differences were observed for VAS or VISA-A changes (p > 0.05). Conclusions: In this uncontrolled retrospective case series, peritendinous collagen injections were feasible and well-tolerated in diabetic patients with Achilles tendinopathy and were associated with clinically relevant improvements in pain and functional outcomes at 6 months. These findings are hypothesis-generating and warrant confirmation in prospective controlled studies. Full article

Background: Anterior cruciate ligament (ACL) rupture, Achilles tendinopathy, and stress fracture are common sports injuries with significant long-term effects on performance and health. Despite similar exposure, injury susceptibility varies among athletes, suggesting a genetic component. Variants in COL1A1, COL5A1, ACTN3, MMP3, and GDF5 genes influence collagen integrity, muscle performance, and extracellular matrix remodelling, making them potential risk factors. Objective: To systematically review associations between five selected genes and musculoskeletal injury risk. Methods: Following PRISMA 2020 guidelines, PubMed, EMBASE, SPORTDiscus, and Web of Science were searched for studies examining these genes in relation to sports injuries. Data were extracted using Covidence and assessed for quality via the Newcastle–Ottawa Scale (NOS). Results: Twenty-six studies (n > 7000) were included. COL1A1 rs1800012 showed a protective effect against ACL rupture; COL5A1 rs1272 and rs13946 increased risk for ACL rupture and Achilles tendinopathy. MMP3 variants (rs679620, 5A/6A) showed variable associations, particularly in combination with COL5A1. ACTN3 R577X was linked to higher muscle and soft tissue injury risk in XX genotype carriers. Evidence for GDF5 rs143383 was limited but suggested a possible association with stress fractures. Conclusions: Genetic variants in COL1A1, COL5A1, MMP3, ACTN3, and GDF5 may influence susceptibility to ACL rupture, Achilles tendinopathy, and stress fractures. Larger, multi-ethnic studies are needed to validate these findings and inform personalised injury prevention strategies. Full article

Background: Tendinopathy remains a prevalent musculoskeletal disorder with limited disease-modifying pharmacotherapy. This study aimed to identify a reparative agent from the traditional medicinal herb Eucommiae Cortex and elucidate its mechanism of action. Methods: A bioactive fraction was first identified through a bioactivity-guided strategy using tenocyte cytoprotection and migration assays, then characterized by UHPLC-HRMS/MS. Its major constituent, aucubin (AU), which mirrors the fraction’s key pharmacological activities, was evaluated both in vitro and in vivo. In H₂O₂-injured tenocytes, AU’s effects on viability, apoptosis, oxidative stress (ROS, MDA, SOD) and inflammation (IL-1β, TNF-α) were assessed, with specific focus on estrogen receptor (ER) pathway involvement using pharmacological tools (17β-estradiol and (R, R)-THC). In a collagenase-induced Achilles tendinopathy model using male SD rats, AU’s therapeutic efficacy was evaluated via multimodal assessment: ultrasonography, histopathology (H&E, Masson’s trichrome, Sirius red), TEM, immunohistochemistry, and biochemical analysis of tissue markers. Results: AU effectively attenuated H₂O₂-induced tenocyte injury by enhancing viability, reducing apoptosis, and mitigating oxidative/inflammatory stress. These effects were mimicked by 17β-estradiol and reversed by the selective ERβ antagonist (R, R)-THC, indicating ERβ dependence. In vivo, AU treatment promoted structural and functional recovery, improved collagen maturity (increased Col I/Col III ratio and fibril diameter), suppressed matrix degradation (MMP-3, MMP-13) and apoptosis, and reduced oxidative stress and inflammation in tendon tissue. Conclusions: This study identifies aucubin as a novel phytoestrogenic compound from Eucommiae Cortex that promotes tendon repair through an ERβ-mediated mechanism. These findings position ERβ activation as a promising therapeutic strategy for tendinopathy and highlight AU as a promising lead compound for further development. Full article

Background: Treatment of chronic painful insertional Achilles tendinopathy is known to be challenging. If non-surgical treatment does not give sufficient relief of symptoms, surgery may be indicated. Treatment with ultrasound (US)- and colour Doppler (CD)-guided wide-awake-local-anaesthetic-no-tourniquet (WALANT) surgery for insertional Achilles tendinopathy is a new approach with promising clinical results. This study aimed to evaluate clinical results of this new approach on patients suffering from insertional Achilles tendinopathy. Methods: Forty-eight consecutive patients with 53 symptomatic tendons (33 men with 34 tendons, mean age 49.3 ± 12.0 years; 14 women with 18 tendons, mean age 55.0 ± 7.4 years) and a duration of more than 12 months with painful insertional Achilles tendinopathy (including tendon, bursae, bone, and plantaris pathology) were included. US- and CD-guided WALANT surgery with removal of pathological bursae, bone, and tendons was used. Immediate weight-bearing loading was allowed, followed by a structured rehabilitation protocol for the first 12 weeks after surgery. VISA-A scores before and after surgery and a questionnaire that evaluated subjective satisfaction with the treatment and current activity level were used. Results: In total, 42/48 patients with 46/53 tendons participated in a 3-year follow-up (mean 34 ± 9 months) by an independent examiner; 39/42 patients with 43/46 tendons were satisfied (n = 37) with the treatment. The mean VISA-A score increased significantly from 41.9 ± 18.2 pre-operatively to 87.7 ± 18.2 post-operatively (p < 0.001). There were three surgical complications, two superficial wound infections, and one minor wound rupture. Conclusions: Patients who suffered from chronic painful insertional Achilles tendinopathy treated with US- and CD-guided WALANT surgery followed by immediate weight-bearing showed high patient subjective satisfaction rates and better functional scores at the 3-year follow-up with a low complication rate. This novel treatment approach warrants more study, including randomised trials comparing it against traditional surgical procedures according to Nunley and Keck and Kelly. Full article

Background/Objectives: Running is associated with increased Achilles Tendon (AT) loading and cross-sectional area (CSA). Achilles tendinopathy is a common unilateral injury. Differences in AT loading variables between dominant and non-dominant lower extremities while running have not been characterized. This study examined the AT loading variables between dominant and non-dominant lower extremities in healthy recreational runners. Methods: Twenty-four females ran at 3.3 m/s (11.88 km/hr) on an instrumented treadmill. Achilles Tendon CSA (AT-CSA) was measured from ultrasound images. Kinematic and kinetic data were used as input into a musculoskeletal model. Paired t-tests examined inter-limb differences in peak vertical ground reaction force, Achilles Tendon-related loading variables (AT force, AT-CSA, AT stress), total gastrocnemius force, soleus force, foot strike angle, and stance time. Results: No differences were shown between dominant and non-dominant lower extremities in stance time, vertical ground reaction force, gastrocnemius and soleus force, AT force, AT-CSA, or AT stress. Foot strike angle was different between limbs (p = 0.015); however, the absolute difference was about 2°. Conclusions: These data indicated that AT loading was similar between dominant and non-dominant lower extremities in healthy female recreational runners. While some asymmetry can be expected during a bilateral task such as running, runners displayed differences in AT force and stress less than 18%. These data may assist clinicians in the assessment and management of runners recovering from AT tendinopathy. Full article

Background: Cavus foot, defined by an increased medial longitudinal arch and often forefoot plantarflexion, alters biomechanics and increases peak plantar pressures, raising the risk of musculoskeletal disorders such as metatarsalgia, Achilles tendinopathy, and gait instability. Custom foot orthoses are the preferred conservative treatment, offering plantar support, pressure redistribution, and reduction in compensatory muscle activity. This study evaluated the medium- and long-term effectiveness of custom orthoses in 71 patients with cavus feet using surface electromyography (sEMG) and the same shoes. Methods: Muscle activity of the peroneus longus, peroneus brevis, and gastrocnemius was recorded during treadmill gait after one and four months of orthotic use. Results: Significant reductions in muscles were observed, especially after four months, confirming greater long-term effectiveness. No residual benefits were found when participants walked without orthoses. Conclusions: These findings support the clinical value of insoles in reducing the compensatory muscle activity in cavus feet and emphasize the importance of investigating their long-term role in biomechanics and potential pathology risk reduction. Full article

Background: Prolotherapy (proliferative therapy) is a nonsurgical regenerative injection technique that introduces small amounts of hyperosmolar dextrose to the site of painful or degenerated tendons or their insertions. Under ultrasound guidance, a 25-gauge needle is used to fenestrate and inject hyperosmolar dextrose into the injured area of the Achilles tendon. This is found to induce the proliferation of new cells, allowing the regeneration of healthy tissue. The purpose of this study was to evaluate the treatment response to prolotherapy in Achilles tendinitis. Methods: We reviewed 132 participants with nontraumatic Achilles tendinopathy. Data were collected retrospectively from electronic health records from January 1, 2014, to December 31, 2017. These participants have Achilles tendinopathy from daily activity. We excluded any traumatic cause, history of Achilles tendon rupture, and tendon pathology. Participants were followed for 12 months; those lost to follow-up were excluded. The duration of pathology, number of prolotherapy sessions, and outcome data were recorded. Musculoskeletal radiologists performed the prolotherapy. We received an exemption from the institutional review board of Boston Medical Center for this study. Results: One hundred thirty-two participants (45 men and 87 women) met the study’s criteria, with a mean age of 55 years (range, 21–80 years). Overall, within 12 months, 98 participants (74.2%) experienced symptom resolution. Seventy-one participants (53.8%) experienced symptom improvement with a single treatment. Thirty-four participants (25.8%) still had symptoms after 12 months. Conclusions: This study demonstrated that prolotherapy yielded excellent results for Achilles tendinitis, particularly for participants without skeletal deformities. No adverse events were reported during the 12-month study. A prospective, comparative, and randomized controlled study with long-term follow-up is needed to determine the efficacy of prolotherapy. (J Am Podiatr Med Assoc 115(6), 2025; doi:10.7547/23-186) Full article