Search Our Scientific Publications & Authors

Foot Ankle Int 2021 Jun 22:10711007211023060. Epub 2021 Jun 22.

Department of General, Trauma, and Reconstructive Surgery, University Hospital Munich, Munich, Germany.

Background: The aim of this study was to assess the patient-reported outcome measures (PROMs) in patients with insertional Achilles tendinopathy (IAT) treated surgically by debridement of all pathologies through a midline-incision trans-achillary approach (MITA).

Methods: This is a retrospective cohort study with current follow-up. Patients treated surgically by a MITA, addressing all pathologies of IAT, with at least 12 months of follow-up were included. Read More

J Am Podiatr Med Assoc 2021 Jun 16. Epub 2021 Jun 16.

Background: Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown that micronized dehydrated human amnion chorion membrane (mdHACM) allograft injection is an effective treatment for plantar fasciitis. Our objective is to present our experience with using mdHACM injection as a treatment for Achilles tendinopathy and report short term treatment outcomes. Read More

Clinics (Sao Paulo) 2021;76:e2803. Epub 2021 Jun 11.

Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Objectives: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners.

Methods: Seventy-two participants (42 men, 30 women; mean age: 37.3±9. Read More

JBJS Rev 2021 06 14;9(6). Epub 2021 Jun 14.

Jacksonville Orthopaedic Institute, Jacksonville, Florida.

Background: Achilles tendinopathy is a common clinical problem that can be either insertional or noninsertional, and effective treatment of each type can vary. We sought to investigate the current evidence on different treatment methods for insertional Achilles tendinopathy with a focus on functional outcomes.

Methods: We performed a systematic review of the available literature using the PubMed/MEDLINE and Cochrane Central Register of Controlled Trials databases. Read More

J Foot Ankle Surg 2021 Apr 30. Epub 2021 Apr 30.

Fellowship-Trained Foot and Ankle Surgeon, Orthopedic Foot and Ankle Center, Worthington, OH.

Various techniques of surgical detachment for treatment of insertional Achilles tendinopathy have been described, including lateral release, medial release, central tendon splitting (CTS), and complete detachment. A systematic review of electronic databases was performed, encompassing 17 studies involving 703 patients and 746 feet, to compare outcomes associated with surgical takedown techniques. Observed results include wound complication rates (CTS 2. Read More

Curr Sports Med Rep 2021 Jun;20(6):327-334

Abstract: Achilles tendinopathy is a common overuse condition that is characterized by degenerative, cumulative tissue microtrauma. It is largely a clinical diagnosis in which the patient typically presents with localized pain that is worse with tendon-loading activities. Imaging modalities may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Read More

Curr Sports Med Rep 2021 Jun;20(6):298-305

Orthopedic Surgery and Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.

Abstract: Treatment of musculoskeletal conditions in athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use. ESWT protocols (describing energy flux density, number of impulses, type of shockwave (focused or radial), number/frequency/duration of treatment session, area of application, and postprocedural therapy protocols) can be adjusted in the clinical setting. Protocols vary across studies, and optimal protocols for most indications are yet to be determined. Read More

J Orthop Translat 2021 Jul 18;29:42-50. Epub 2021 May 18.

Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.

Background: Tendons are the force transferring tissue that enable joint movement. Excessive mechanical loading is commonly considered as a primary factor causing tendinopathy, however, an increasing body of evidence supports the hypothesis that overloading creates microdamage of collagen fibers resulting in a localized decreased loading on the cell population within the damaged site. Heterotopic ossification is a complication of late stage tendinopathy, which can significantly affect the mechanical properties and homeostasis of the tendon. Read More

BMC Musculoskelet Disord 2021 Jun 5;22(1):519. Epub 2021 Jun 5.

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan.

Background: Dehydroepiandrosterone (DHEA), an adrenal steroid, has a protective role against diabetes. This study aimed to investigate the in vitro and in vivo protective effects of DHEA against high glucose-induced oxidative stress in tenocytes and tendons.

Methods: Tenocytes from normal Sprague-Dawley rats were cultured in low-glucose (LG) or high-glucose (HG) medium with or without DHEA. Read More

Am J Sports Med 2021 Jun;49(7):1707-1710

Wien Klin Wochenschr 2021 Jun 3;133(11-12):560-567. Epub 2021 Jun 3.

High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.

Objective: The purpose was to introduce the Vienna morphological Achilles tendon score (VIMATS), to evaluate its reproducibility and to assess its clinical application.

Methods: In 38 patients a total number of 40 painful ATs and 20 volunteers were examined on a 3T magnetic resonance imaging (MRI) scanner using a standard MRI protocol. In 20 patients clinical scoring according to the Achilles tendon rupture score was available. Read More

J Sports Sci 2021 Jun 1:1-7. Epub 2021 Jun 1.

Program in Physical Therapy, Oregon State University - Cascades, Bend, OR, USA.

Achilles tendinopathy (AT) and medial tibial stress syndrome (MTSS) are two of the most common running-related injuries. In a previous study investigating running biomechanics before and after a six-week transition to maximal running shoes, two runners dropped out of this study due to Achilles pain and shin pain, respectively. The purpose of this case series was to investigate running biomechanics in those two runners, identifying potential causes for injury in relation to maximal shoe use. Read More

J Orthop Sports Phys Ther 2021 Jun 1:1-28. Epub 2021 Jun 1.

University of Delaware, Delaware Tendon Research Group, Department of Physical Therapy, Newark, DE.

Objective: To identify latent subgroups among patients with Achilles tendinopathy, describe patient characteristics and clinical attributes that defined each subgroup, and develop a clinical classification model for subgroup membership.

Design: Cross-sectional study.

Methods: 145 (73 men) participants (age (mean±SD) 51±14 years) with clinically diagnosed Achilles tendinopathy completed a baseline evaluation including demographics and medical history, patient-reported outcome measures, clinical exam, tendon structure measures using ultrasound imaging and continuous shear wave elastography, and a functional test battery. Read More

J Clin Med 2021 May 17;10(10). Epub 2021 May 17.

Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.

No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Read More

BMC Sports Sci Med Rehabil 2021 May 25;13(1):57. Epub 2021 May 25.

Physiotherapy Department, School of Primary and Allied Health Care, Monash University, Frankston, Melbourne, Victoria, 3199, Australia.

Background: One potential reason for disparate outcomes of exercise for Achilles tendinopathy is poor knowledge about whether exercise parameters (i.e. different exercise doses) influence outcome. Read More

Surg Radiol Anat 2021 May 25. Epub 2021 May 25.

Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.

Purpose: This study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy.

Methods: We retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10. Read More

J Bone Joint Surg Am 2021 May 24. Epub 2021 May 24.

Escola Paulista de Medicina-Universidade Federal de São Paulo, São Paulo, Brazil.

Background: There remains a lack of consensus regarding the treatment of Achilles insertional tendinopathy. The condition is typically treated with eccentric exercises despite the absence of satisfactory and sustained results. Shockwave therapy was presented as an alternative, but there is a paucity of literature, with good outcomes, supporting its use. Read More

J Foot Ankle Surg 2021 Apr 20. Epub 2021 Apr 20.

Student, Rosalind Franklin University, Chicago, IL.

The surgical procedure for Insertional Achilles tendinopathy (IAT) varies widely with no consensus as to approach and documenting return to activity (RTA). This study presents outcomes of surgery for IAT by a single surgeon, documenting activity level and return to activity. From January 2001 through January 2018, 166 procedures were reviewed. Read More

Foot Ankle Int 2021 May 24:10711007211003871. Epub 2021 May 24.

Department of Orthopaedics, Sirindhorn Hospital, Bangkok, Thailand.

Background: No studies have compared early vs conventional postoperative weightbearing following suture bridge Achilles tendon reattachment. We, therefore, evaluated postoperative functional outcomes in these patients.

Methods: We collected data on 49 patients who underwent surgical treatment of insertional Achilles tendinopathy using a central Achilles tendon-splitting approach and reattachment with suture bridge technique by a single surgeon. Read More

Phys Ther Sport 2021 Jul 9;50:139-144. Epub 2021 May 9.

Department of Physical Therapy, University of Delaware, Tendon Research Group, USA. Electronic address:

Objectives: Fear of movement may be a source of systemic bias in studies reporting functional deficits in patients with Achilles tendinopathy. The purpose of this study was to assess the effects of kinesiophobia on completion rate and performance on tests evaluating lower extremity function, while controlling for self-reported pain.

Design: Cross-sectional study; SETTING: Tendon research laboratory. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 21. Epub 2021 May 21.

Department of Orthopaedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.

Purpose: The Victorian Institute of Sport Assessment (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized.

Methods: The systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. Read More

Phys Ther Sport 2021 Jul 6;50:145-152. Epub 2021 May 6.

University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, the Netherlands. Electronic address:

Objective: to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function.

Design: cross-sectional study.

Setting: online survey platform. Read More

J Bodyw Mov Ther 2021 Apr 8;26:214-219. Epub 2020 Sep 8.

Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.

Background/purpose: Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. Read More

Knee Surg Sports Traumatol Arthrosc 2021 May 15. Epub 2021 May 15.

Department of Orthopedic Surgery, Amsterdam UMC, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.

Purpose: Aims of this study are to evaluate the current terminology and assess the influence of the latest proposals on the terminology used for Achilles tendon-related disorders in both daily practice and literature.

Methods: (1) All orthopedic surgeons experienced in the field of foot and ankle surgery of the Ankleplatform Study Group were invited to participate in this survey by email. They were requested to fill out a survey on terminology in six typical cases with Achilles tendon-related disorders. Read More

Foot Ankle Int 2021 May;42(5):671-672

Foot Ankle Int 2021 May;42(5):669-670

BMC Sports Sci Med Rehabil 2021 May 13;13(1):51. Epub 2021 May 13.

Divisão de Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Avenida Brasil, 500, RJ, zip code 20940-070, Rio de Janeiro, Brazil.

Background: High levels of the tumor necrosis factor alpha (TNF-α) induce apoptosis and pro-inflammatory effects for primary degeneration of tendon and development of tendinopathy. The aim of this study was to investigate the association between the TNF-α polymorphisms and tendinopathy in athletes.

Methods: Two hundred and seventy athletes (135 tendinopathy cases and 135 controls) were included and genotyped (TNF-α -1031T > C; -857 C > T; -308G > A) using TaqMan validated assays. Read More

Musculoskelet Sci Pract 2021 Aug 30;54:102388. Epub 2021 Apr 30.

Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia. Electronic address:

Objective: Impaired left/right discrimination of an affected body part has been observed in various chronic pain states. This study aimed to examine whether people with unilateral chronic Achilles tendinopathy also present with impaired left/right discrimination.

Design: Cross-sectional study. Read More

J Am Acad Orthop Surg Glob Res Rev 2021 May 4;5(5):e21.00008. Epub 2021 May 4.

From the Foot and Ankle Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (Greene and J. T. Smith); the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S. E. Smith); and the STRATUS Center for Simulation in Medical Education, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (S. E. Smith).

Pathology associated with the plantaris includes rupture of the tendon and an association with mid-substance Achilles tendinopathy in some patients. There have only been two previous case reports in the literature in English language describing snapping of the plantaris tendon. We present a case report of a 15-year-old female competitive dancer who described pain and an audible popping at the medial margin of the Achilles tendon while squatting. Read More

J Sci Med Sport 2021 Apr 19. Epub 2021 Apr 19.

Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.

Objectives: To analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients.

Design: Prospective cohort study.

Methods: Patients with clinically-diagnosed chronic midportion AT were conservatively treated. Read More