Ultrasonographic Evaluation of Achilles Tendon Thickness in the Emergency Department: A Novel Measurement Method

Abstract

Objective: Increased Achilles tendon thickness is associated with hypercholesterolemia and cardiovascular disease, and ultrasonography is the preferred method for its assessment. This study aimed to evaluate the agreement between Achilles tendon ultrasonographic measurements obtained in different supine positions and those acquired using the standard prone technique. Materials and Methods: This prospective methodological study included 180 healthy adults (70 women, 110 men), representing 360 Achilles tendons. Individuals with systemic disease, regular medication use, or Achilles tendon pathology were excluded. Tendon thickness, width, and cross-sectional area were measured ultrasonographically using four positioning techniques: the conventional prone position (Method 1) and three supine alternatives: leg extended beyond the examination table (Method 2), ankle over the contralateral knee (Method 3), and hip and knee flexed at 90° (Method 4). Measurements were obtained 2 cm proximal to the calcaneal insertion. Results: No significant differences were found between Method 1 and Method 2 for tendon thickness, width, or cross-sectional area (For all parameters; p>0.05). Strong correlations were observed for thickness and cross-sectional area (r>0.8), while width showed a moderate correlation (r=0.6-0.8). Conclusion: Method 2 demonstrated good agreement with the standard prone technique and may serve as a practical alternative for Achilles tendon ultrasonography, particularly when prone positioning is not feasible. This approach may facilitate cardiovascular risk assessment using Achilles tendon thickness in a wider range of clinical settings.

Keywords

• Achilles tendon
• cardiovascular risk
• emergency medicine
• ultrasonography

Ethical Statement

This study was approved by the Non-Interventional Ethics Committee of Sakarya University, Republic of Turkey (Date: 19.09.2024, decision no: E-43012747-050.04-399468-15). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants. The study is registered with ClinicalTrials.gov, No. NCT06867211.

Aşil Tendon Kalınlığının Acil Serviste Ultrasonografik Değerlendirmesi: Yeni Bir Ölçüm Yöntemi

Abstract

Amaç: Artmış Aşil tendonu kalınlığı, hiperkolesterolemi ve kardiyovasküler hastalık ile ilişkilidir ve değerlendirilmesi için tercih edilen yöntem ultrasonografidir. Bu çalışma, farklı supin (sırtüstü) pozisyonlarda elde edilen Aşil tendonu ultrasonografik ölçümleri ile standart pron (yüzüstü) tekniği kullanılarak elde edilen ölçümler arasındaki uyumu değerlendirmeyi amaçlamıştır. Materyal ve Metot: Bu prospektif metodolojik çalışmaya 180 sağlıklı yetişkin (70 kadın, 110 erkek) dahil edilmiştir ve toplamda 360 Aşil tendonu değerlendirilmiştir. Sistemik hastalığı olan, düzenli ilaç kullanan veya Aşil tendon patolojisi olan bireyler dışlandı. Tendon kalınlığı, genişliği ve kesitsel alanı dört farklı pozisyonda ultrasonografi ile ölçüldü: standart yüzüstü yöntem (Yöntem 1), bacağı masa dışına uzatılmış sırtüstü (Yöntem 2), ayak bileği karşı diz üzerine yerleştirilmiş sırtüstü (Yöntem 3) ve kalça ile diz 90° fleksiyonda sırtüstü (Yöntem 4). Ölçümler kalkaneal insersiyonun 2 cm proksimalinden yapıldı. Bulgular: Yöntem 1 ile Yöntem 2 arasında tendon kalınlığı, genişliği ve kesitsel alan açısından anlamlı bir fark saptanmadı (Tüm parametreler için p>0.05). Kalınlık ve kesitsel alan ölçümlerinde güçlü (r>0.8), genişlik ölçümlerinde ise orta düzeyde korelasyon bulundu(r=0.6-0.8). Sonuç: Yöntem 2, standart yüzüstü yöntemle iyi uyum göstermiş olup, yüzüstü pozisyonun uygulanamadığı hastalarda Aşil tendon ultrasonografisi için pratik bir alternatif olabilir. Bu yöntem, Aşil tendon kalınlığının kardiyovasküler risk değerlendirmesinde daha geniş hasta gruplarında kullanılmasına katkı sağlayabilir.

Keywords

• Acil tıp
• aşil tendonu
• kardiyovasküler risk
• ultrasonografi

Ethical Statement

Bu çalışma, Türkiye Cumhuriyeti Sakarya Üniversitesi Müdahalesel Olmayan Etik Komitesi tarafından onaylanmış (Tarih: 19.09.2024, karar no: E-43012747-050.04-399468-15). Çalışma, Helsinki Bildirgesi uyarınca gerçekleştirilmiştir. Tüm katılımcılardan bilgilendirilmiş onayı alınmıştır. Çalışma, ClinicalTrials.gov, No. NCT06867211.

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