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Soft Tissue Assessment using Shear wave Elastography

Achilles tendinopathy

The Achilles tendon is commonly injured during sport and other physical activities. Mid-portion Achilles tendinopathy in particular can affect anyone, especially those involved in high-impact sports. The disorder involves degenerative changes rather than inflammation. In addition, neovascularization seems to contribute to the pain. Achilles tendinopathy can be challenging to treat and takes a long time to recover from. There is limited evidence on treatments and no established protocols for monitoring recovery. Ultrasound is used to diagnose it but its role in tracking rehabilitation progress is unclear. We have a program of work to quantitatively assess tendon mechanical properties using Elastography.  This emerging ultrasound technology is used it to understand how factors like loading, aging and treatments impact recovery.

The Effect of Loading on Plantar Fascia Thickness

While ultrasound measures of increased plantar fascia thickness and reduced shear wave velocity can differentiate unhealthy from healthy tissues, measurement protocols lacks standardization for key parameters like site location, ankle positioning, and impact of activities performed prior to measurement. Our research aims to address critical gaps regarding the need to precondition the plantar fascia when taking thickness and shear wave velocity ultrasound measurements in vivo. Specifically, our program of work investigates two key questions – 1) What impact routine loading activities, like walking or stretching, have on acute ultrasound measures; and 2) Should a preconditioning protocol be performed before acquiring ultrasound data to improve reliability? By evaluating the immediate effects of common preconditioning states and the need for standardizing tissue preparation prior to scanning, we hope to inform optimal protocols for plantar fascia ultrasound assessment. Standardized methods will facilitate data comparisons across studies and improve monitoring clinically. 

Some of of our key papers

Supersonic shear wave elastography of human tendons is associated with in vivo tendon stiffness over small strains.

Mifsud, T., Chatzistergos, P., Maganaris, C., Chockalingam, N., Padhiar, N., Stafrace, K.M. and Gatt, A., 2023.  Journal of Biomechanics, 152, p.111558.

Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties.

Mifsud, T., Gatt, A., Micallef-Stafrace, K., Chockalingam, N. and Padhiar, N., 2023.  Journal of Foot and Ankle Research, 16(1), p.23.

Panagiotis Chatzistergos

Associate Professor

Prof. Nachiappan Chockalingam

Professor Of Clinical Biomechanics

CBRT Staffordshire University