Metabolic and biomechanical links to Achilles tendinopathy features on ultrasounds in a long distance running cohort


Orla Ni Mhuircheartaigh (1), Diana Gheata (1), David Kane (1), Ronan Mullan (1), Aisling Brennan (2), Umair Amwar Jilani (1), Eanna Falvey (3)


1. Rheumatology Department, Adelaide and Meath Hospital, Dublin 24; 2. Physiotherapy Department, Adelaide and Meath Hospital, Dublin 24; 3. Sports and Exercise Medicine MSc, University College Cork, Cork


Achilles tendinopathy is a common injury that is seen in long distance runners. Due to tendons’ relative, avascular nature and slow healing they often lead to prolonged recovery periods. The process of tendon injury precedes clinical symptoms. Ultrasound has been shown to be an effective tool for visualizing tendon structure. Pre-clinical ultrasound scanning of the Achilles tendons in athletes can identify at-risk groups and could potentially lead to a window of opportunity for early detection and preventative interventions. This may be more important in patients with a higher metabolic or biomechanical risk profile.


Aim 1: To identify the rates of features of Achilles Tendinopathy in both symptomatic and asymptomatic long-distance runners

Aim 2: To determine the metabolic and biomechanical risk profile that this running cohort have and determine if it has any correlation with their risk of having features of Achilles tendinopathy


20 athletes (runners and triathletes) were recruited. Data on a range of training factors, injury history, blood paraments, metabolic indices, biomechanical indices and ultrasoographic features of AT were recorded.


The most common feature of tendinopathy found was tendon thickness.100% of the symptomatic group had increased AT mid portion thickness. The majority of the asymptomatic group also had mid-portion thickness (Approx 65%). There was a significant difference in the % thickness between these two groups (p=0.006 left 0.000 right). The mean distance above the calcaneal insertion at which the AT was thickened was 3.65cm (left), 3.61cm (right). Approx half of the cohort 55%-right, 60% left had a bone spur. There was no correlation between the presence of a bone spur and a symptomatic AT (p=0.463 left, p=0.364 right). There was a significant correlation between tendon volume and the development of a symptomatic Achilles tendinopathy on the left (p=0.040). There was no significant association found between any metabolic or biomechanical indices and the AT data obtained.


The degree of AT thickening may be predictive of the development of clinical symptoms. Interesting in the AT data on the left side the total tendon volume was predictive of the development of symptoms, although this finding was not observed on the right side this may be limited by power and further analysis of this concept may be worth exploring. The prevalence of a bone spur is not as common as one would have expected and the lack of any associated risk with Achilles tendinopathy was also an interesting finding. Although there was no correlation found with foot alignment and AT data this is only one of many biomechanical factors involved in the running stride and a full biomechanical video analysis focusing on forces around the AT and the ultrasound features would be another interesting angle to look into in future studies