In vivo and In vitro Assessment of Non-operative Therapies for Insertional Achilles Tendinopathy
(a) B-mode ultrasound image and (b) compressive
strain map of the Achilles tendon-calcaneus insertion
in a healthy subject performing a heel lift.
Note the high (negative) compressive strains
where the calcaneus (labeled "C") impinges on the tendon
(labeled "AT"). (Enlarged image)
Insertional Achilles tendinopathy (IAT) is a common and debilitating condition that is challenging to treat clinically. Non-surgical interventions for this disease have been largely ineffective with approximately 50% of IAT patients failing conservative care and undergoing surgery. To improve clinical outcomes for IAT patients, there is a need to develop new standards for treatment of this disease.
In collaboration with Dr. A. Samuel Flemister (Orthopaedics) and Dr. Michael Richards (Surgery), our approach to addressing this important clinical problem is to optimize exercise-based protocols for non-operative care of IAT using a combined basic science and clinical approach. Our current clinical research is aimed towards establishing a benchmark for successful treatment of IAT in order to enable rapid screening of untested and novel therapies. To this end, we are using state-of-the-art, ultrasound-based elastography techniques developed by Dr. Richards to compare the location-dependent pattern of strain in IAT tendons during everyday activities before and after surgery. Meanwhile, in the laboratory, we are performing mechanical tests on explants of human IAT tendons obtained after debridement surgery to assess the changes in material properties that accompany this disease. In addition, we are subjecting viable explants of human IAT tendons to simulated exercise interventions in a microscope-mounted bioreactor. Data obtained from this research will help guide improved conservative care in patients with IAT.
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