Ultrasonographic Assessment of Normal Achilles Tendon Thickness and Width in the Asymptomatic Sudanese Population

ORIGINAL ARTICLE
Marwa H. Mohammed, Tasnim Badreldeen Elameen Abdalla, Raga Ahmed Abouraida, Magbool Alelyani, Awadia Gareeballah, Ala M. A Elgyoum, Mogahid M. A. Zidan, Abbas Omer, Maisa Elzaki, Batil Alonazi, Moram A. Fagiry, Mustafa Z. Mahmoud

 
International Journal of Biomedicine. 2023;13(1):95-100.
DOI: 10.21103/Article13(1)_OA12
Originally published March 3, 2023

Abstract: 

Background: The goal of this study was to measure normal Achilles tendon (AT) thickness and width in adult asymptomatic Sudanese people using high-resolution ultrasound.
Methods and Results: The study was conducted on members of a healthy Sudanese population (120 volunteers: 73/60.8% women and 47/39.2% men), who were chosen using simple random sampling. The study cases were all healthy people with no history of AT injuries or abnormalities. All patients were examined using a Toshiba Xairo200 linear transducer with a frequency range of 7-10MHz. All measurements were taken from a transverse scan at the calcaneus bone level of the AT insertion and 2 to 3cm above the calcaneus. The age group 20-27 had the most participants (44.2%), followed by 36-43 years (19.2%), 28-35 years (15.8%), 52-60 years (14.2%), and 44-51 years (6.7%). The study revealed that the mean age of participants was 34.19±12.29 years, height - 164±0.081 cm, weight - 67.22±15.97 kg, and BMI - 24.38±5.84 kg/m2. The mean thickness and width of the AT were 4.36±0.81 mm and 21.85±3.23 mm, respectively, at its insertion into the calcaneus, and 4.63±0.77 mm and 12.20±1.37 mm, respectively, at the level 2-3 cm above the insertion. We found significant differences according to gender between the AT thickness and width at insertion into the calcaneus and above insertion and no statistically significant differences between the AT measurement's right and left side data.
Conclusion: The study found gender differences in the AT thickness and width at insertion into the calcaneus and 2-3 cm above the insertion. No statistically significant differences were detected between the AT measurement’s right and left side data.Age, weight, height, and BMI correlated with the thickness and width of the AT at its insertion into the calcaneus and 2-3 cm above. Furthermore, additional research should be conducted using an extended field-of-view technology to measure the length of the AT tendon in the Sudanese population.

Keywords: 
Achilles tendon • high-resolution ultrasound • thickness • width
References: 
  1. Czyrny Z. Standards for musculoskeletal ultrasound. J Ultrason. 2017 Sep;17(70):182-187. doi: 10.15557/JoU.2017.0027. 
  2. Grassi W, Filippucci E, Farina A, Cervini C. Sonographic imaging of tendons. Arthritis Rheum. 2000 May;43(5):969-76. doi: 10.1002/1529-0131(200005)43:5<969::AID-ANR2>3.0.CO;2-4.
  3. Balint PV, Kane D, Wilson H, McInnes IB, Sturrock RD. Ultrasonography of entheseal insertions in the lower limb in spondyloarthropathy. Ann Rheum Dis. 2002 Oct;61(10):905-10. doi: 10.1136/ard.61.10.905.
  4. D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler: a cross-sectional study. Arthritis Rheum. 2003 Feb;48(2):523-33. doi: 10.1002/art.10812.
  5. Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis. 2004 Aug;63(8):988-94. doi: 10.1136/ard.2003.015081.
  6. Olivieri I, Barozzi L, Padula A, De Matteis M, Pierro A, Cantini F, Salvarani C, Pavlica P. Retrocalcaneal bursitis in spondyloarthropathy: assessment by ultrasonography and magnetic resonance imaging. J Rheumatol. 1998 Jul;25(7):1352-7.
  7. Filippucci E, Aydin SZ, Karadag O, Salaffi F, Gutierrez M, Direskeneli H, Grassi W. Reliability of high-resolution ultrasonography in the assessment of Achilles tendon enthesopathy in seronegative spondyloarthropathies. Ann Rheum Dis. 2009 Dec;68(12):1850-5. doi: 10.1136/ard.2008.096511. E
  8. Rumack CM, Levine D. Diagnostic ultrasound. Fifth Edition. Elsevier, Inc; 2018.
  9. Jacobson JA. Fundamentals of Musculoskeletal Ultrasound. Third Edition. Elsevier, Inc; 2018.
  10. Kayser R, Mahlfeld K, Heyde CE. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Br J Sports Med. 2005 Nov;39(11):838-42; discussion 838-42. doi: 10.1136/bjsm.2005.018416.
  11. Beatrice S. F. Pang, Michael Ying. Sonographic measurement of Achilles tendons in asymptomatic subjects. Hongkong 1 Oct, 2006.
  12. Aydın SZ, Filippucci E, Atagündüz P, Yavuz Ş, Grassi W, Direskeneli H. Sonographic measurement of Achilles tendon thickness in seronegative spondyloarthropathies. Eur J Rheumatol. 2014 Mar;1(1):7-10. doi: 10.5152/eurjrheum.2014.002.
  13. van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA, Tol JL, Weinans H. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med. 2010 Dec;44(16):1153-9. doi: 10.1136/bjsm.2009.061010. 
  14. Civeira F, Castillo JJ, Calvo C, Ferrando J, de Pedro C, Martínez-Rodés P, Pocoví M. Tamaño del tendón de Aquiles por ecografía de alta resolución en población sana. Relación con las concentraciones lipídicas [Achilles tendon size by high resolution sonography in healthy population. Relationship with lipid levels]. Med Clin (Barc). 1998 Jun 20;111(2):41-4. Spanish.
  15. de Mello RAF, Marchiori E, dos Santos AASMD, Neto GT. [Morphometric evaluation of Achilles tendon by ultrasound]. Radiologia Brasileira. 2006;39(3):161-165. [Article in in Portuguese].
  16. Canbolat M, Ozba D, Ozdemir Z, Demirtafl G,  Kafkas AS. Effects of physical characteristics, exercise and smoking on morphometry of human Achilles tendon: an ultrasound study. Anatomy. 2015;9(3):128–134.
  17. Abate M, Schiavone C, Di Carlo L, Salini V. Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index. Clin Rheumatol. 2012 Jul;31(7):1109-13. doi: 10.1007/s10067-012-1955-y.

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Received December 8, 2022.
Accepted February 18, 2023.
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