Kim Du-Hwan, Choi Jae-Hyeong, Park Chul-Hyun, Park Hee-Jin, Yoon Kyung-Jae, Lee Yong-Taek
Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea.
Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.
J Clin Med. 2021 May 17;10(10):2165. doi: 10.3390/jcm10102165.
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. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups ( = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups ( < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups ( = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups ( < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.
关于超声检查（US）测量跟腱厚度在诊断跟腱止点性肌腱病中的诊断作用或临界值，目前尚无共识。本研究旨在评估超声测量跟腱厚度和回声性在足跟痛患者跟腱止点性肌腱病诊断中的应用价值，并将结果与足底筋膜炎患者的足底筋膜测量结果进行比较。我们对2016年2月至2020年12月在一家三级医院足部诊所出现单侧或双侧足跟痛的连续患者进行了超声检查。每次超声评估均测量跟腱和足底筋膜止点区域的厚度和回声性。我们回顾性比较了跟腱止点性肌腱病或足底筋膜炎患者与正常对照组之间的这些参数，并分析了这些参数的诊断价值。根据临床诊断，44只足被诊断为跟腱止点性肌腱病，109只足被诊断为足底筋膜炎，32只足被分类为正常。足底筋膜炎组与正常对照组之间足底筋膜厚度存在显著差异（ = 0.032）。足底筋膜炎组与正常组之间足底筋膜回声性也存在显著差异（ < 0.001）。然而，跟腱止点性肌腱病组与正常组之间跟腱止点区域厚度无显著差异（ = 0.132）。跟腱止点性肌腱病组与正常组之间跟腱止点区域回声性存在显著差异（ < 0.001）。与足底筋膜炎不同，超声测量跟腱止点区域的厚度可能无法反映跟腱止点性肌腱病的临床状况。
