Browsing by Author "Alghamdi, Nabeel Hamdan"
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Item Immediate and Short-Term Effects of In-Shoe Heel-Lift Orthoses on Clinical and Biomechanical Outcomes in Patients With Insertional Achilles Tendinopathy(Orthopaedic Journal of Sports Medicine, 2024-02-07) Alghamdi, Nabeel Hamdan; Pohlig, Ryan T.; Seymore, Kayla D.; Sions, Jaclyn Megan; Crenshaw, Jeremy R.; Grävare Silbernagel, KarinBackground: Physical therapists frequently employ heel lifts as an intervention to reduce Achilles tendon pain and restore function. Purpose: To determine the short-term effect of heel lifts on clinical and gait outcomes in participants with insertional Achilles tendinopathy (IAT). Study Design: Case series; Level of evidence, 4. Methods: Participants with IAT underwent eligibility screening and completed assessments at baseline and 2 weeks later. Primary outcomes included symptom severity (Victoria Institute of Sports Assessment-Achilles [VISA-A]), gait analysis with the 10-m walk-test at 2 speeds (normal and fast), and pain during walking. Pain and gait analysis were assessed under 3 conditions: before fitting 20-mm heel lifts, immediately after heel-lift fitting, and after 2 weeks of wearing heel lifts. Ultrasound images and measurements at the Achilles insertion were obtained from prone and standing positions (with and without heel lifts). Spatiotemporal gait parameters and tibial tilt angles were evaluated at normal speed using inertia measurement units during the 3 study conditions. Differences between the conditions were analyzed using paired t test or analysis of variance. Results: Overall, 20 participants (12 female, 13 with bilateral IAT; mean age, 51 ± 9.3 years; mean body mass index 31.6 ± 6.8 kg/m2) completed all assessments. Symptom severity (VISA-A) of the more symptomatic side significantly improved at 2 weeks (60 ± 20.6) compared with baseline (52.2 ± 20.4; P < .01). Pain during gait (Numeric Pain Rating Scale) was significantly reduced immediately after heel-lift fitting (0.7 ± 2.0) when compared with baseline (2.2 ± 2.7, P = .043). Spatiotemporal gait parameters and tibial tilt angle before and after using heel lifts at normal walking speed were not significantly different; however, gait speed, stride length, and tibial tilt angle on both sides increased significantly immediately after using heel lifts and were maintained after 2 weeks of wear. Conclusion: Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed.Item Insertional Achilles tendinopathy: the role of structural factors on symptom and disability outcomes(University of Delaware, 2022) Alghamdi, Nabeel HamdanAbout one out of every three patients with Achilles tendinopathy will have insertional Achilles tendinopathy. Pain, impaired ankle function, morning stiffness, and, in some cases, swelling near the insertion of the Achilles tendon are characteristics of insertional Achilles tendinopathy. The incidence rate increases as individuals get older or develop metabolic disorders. When conservative therapy fails to improve the symptoms and disability, patients with functional impairments undergo invasive interventions such as injections or surgeries. Understanding the mechanisms behind the disparities in the effects of various treatments. and the severity and chronicity of insertional Achilles tendinopathy requires further research. The purpose of this dissertation was to understand the role of structures at the Achilles insertion on injury severity and if the structures affect the symptom and gait in adults with insertional Achilles tendinopathy. ☐ In the first aim of this dissertation, we established the reliability and validity of using ultrasound imaging for measuring the insertional Achilles tendon size. Our findings suggest that ultrasound imaging is a reliable method to evaluate structures near the insertion of the Achilles tendon. While the ultrasound measurements were found to be good-to-excellent for inter-tester reliability, and excellent for intra-tester and procedural reliability, we found poor-to-good agreement between ultrasound imaging and cadaveric measurements. In the second aim, we showed the structural differences between insertional versus midportion Achilles tendinopathy. Structure related pathologies at the insertion were greater in insertional compared to midportion Achilles tendinopathy, but measurement-related anatomical features did not differ between groups suggesting no relation to injury development. In the third aim, none of the structural measurements at the Achilles insertion related to symptom severity, nor gait parameters during walking at one’s normal speed in individuals with insertional Achilles tendinopathy. Finally, in the fourth aim, we found that using in-shoe heel lifts can decrease compression at the insertion by changing tendon insertion angle measurement, which instantly reduced pain and symptom severity. The effect lasted two weeks in both individuals with and without calcification and/or bony deformity. With heel lifts, patients' walking speed increased, and they were satisfied with the treatment, with no adverse events reported.