Utility of Ultrasound for Imaging Osteophytes in Patients With Insertional Achilles Tendinopathy
Related Experiment Video
Updated: Mar 27, 2026
Ultrasound Tissue Characterization of Human Achilles Tendon by Stability Quantification of Echo Patterns
Published on: September 5, 2025
Ruth L Chimenti1, Peter C Chimenti2, Mark R Buckley1
1Department of Biomedical Engineering, University of Rochester, Rochester, NY.
Objectives:
To examine (1) the validity of ultrasound imaging to measure osteophytes and (2) the association between osteophytes and insertional Achilles tendinopathy (IAT).
Design:
Case-control study.
Setting:
Academic medical center.
Participants:
Persons with chronic unilateral IAT (n=20; mean age, 58.7±8.3y; 10 [50%] women) and age- and sex-matched controls (n=20; mean age, 57.4±9.8y; 10 [50%] women) participated in this case-control study (N=40).
Interventions:
Not applicable.
Main Outcome Measures:
Symptom severity was assessed using the Foot and Ankle Ability Measure, the Victorian Institute of Sport Assessment-Achilles questionnaire, and the numerical rating scale. Length of osteophytes was measured bilaterally in both groups using ultrasound imaging, as well as on the symptomatic side of the IAT group using radiography. The intraclass correlation coefficient was used to examine the agreement between ultrasound and radiograph measures. McNemar, Wilcoxon signed-rank, and Fisher exact tests were used to compare the frequency and length of osteophytes between sides and groups. Pearson correlation was used to examine the association between osteophyte length and symptom severity.
Results:
There was good agreement (intraclass correlation coefficient, ≥.75) between ultrasound and radiograph osteophyte measures. There were no statistically significant differences (P>.05) in the frequency of osteophytes between sides or groups. Osteophytes were larger on the symptomatic side of the IAT group than on the asymptomatic side (P=.01) and on the left side of controls (P=.03). There was no association between osteophyte length and symptom severity.
Conclusions:
Ultrasound imaging is a valid measure of osteophyte length, which is associated with IAT. Although a larger osteophyte indicates tendinopathy, it does not indicate more severe IAT symptoms.
