Alghamdi, Nabeel Hamdan2023-01-032023-01-032022https://udspace.udel.edu/handle/19716/31969About 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.Achilles tendinitisGaitInsertional Achilles tendinopathyStructureUltrasound imagingThesis1356736024https://doi.org/10.58088/fsec-0r302022-08-10en