The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons · 2026
Radiographic Parameters Associated with Insertional Achilles Tendinopathy.
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Kızkapan Turan Bilge, Kunt Cihan, Güzel Aybars, Koputan Oğulcan
Аннотация
BACKGROUND: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain, and calcaneal morphology and hindfoot alignment may contribute to its development.
PURPOSE: To compare ankle and hindfoot alignment parameters between patients with IAT and healthy controls, evaluate their relationship with tendon thickness, and identify independent radiographic predictors.
STUDY DESIGN: Retrospective case-control study; Level of Evidence, Level III.
METHODS: Overall, 313 individuals (116 IAT, 197 controls) were included. Weight-bearing radiographs and magnetic resonance imaging (MRI) were used to measure ankle and hindfoot parameters, including the Fowler-Philip angle, posterior tuberosity inclination angle (PTIA), Chauveaux angle, bump height, and Achilles tendon thickness. Group comparisons, Spearman correlation, and multivariate logistic regression were performed (p < 0.05).
RESULTS: The Fowler-Philip angle, PTIA, Chauveaux angle, bump height, X/Y ratio, and Achilles and Achilles-plantar fascia angles were significantly higher in the IAT group; the calcaneal pitch angle and arch height ratio were lower (p = 0.040 and 0.030). Tendon thickness was increased in the IAT group (p < 0.001) and correlated positively with the Fowler-Philip angle (ρ = 0.61) and PTIA (ρ = 0.58), and negatively with the calcaneal pitch angle and arch height ratio. Independent predictors were the Fowler-Philip angle (odds ratio [OR] 1.26; p < 0.001), PTIA (OR 1.15; p = 0.014), bump height (OR 1.21; p = 0.005), and tendon thickness (OR 1.23; p = 0.002).
CONCLUSIONS: The Fowler-Philip angle, PTIA, bump height, and increased tendon thickness were independently associated with IAT and may enhance radiographic diagnosis and structural characterization.
LEVEL OF EVIDENCE: Level III, Retrospective Comparative Study.
PURPOSE: To compare ankle and hindfoot alignment parameters between patients with IAT and healthy controls, evaluate their relationship with tendon thickness, and identify independent radiographic predictors.
STUDY DESIGN: Retrospective case-control study; Level of Evidence, Level III.
METHODS: Overall, 313 individuals (116 IAT, 197 controls) were included. Weight-bearing radiographs and magnetic resonance imaging (MRI) were used to measure ankle and hindfoot parameters, including the Fowler-Philip angle, posterior tuberosity inclination angle (PTIA), Chauveaux angle, bump height, and Achilles tendon thickness. Group comparisons, Spearman correlation, and multivariate logistic regression were performed (p < 0.05).
RESULTS: The Fowler-Philip angle, PTIA, Chauveaux angle, bump height, X/Y ratio, and Achilles and Achilles-plantar fascia angles were significantly higher in the IAT group; the calcaneal pitch angle and arch height ratio were lower (p = 0.040 and 0.030). Tendon thickness was increased in the IAT group (p < 0.001) and correlated positively with the Fowler-Philip angle (ρ = 0.61) and PTIA (ρ = 0.58), and negatively with the calcaneal pitch angle and arch height ratio. Independent predictors were the Fowler-Philip angle (odds ratio [OR] 1.26; p < 0.001), PTIA (OR 1.15; p = 0.014), bump height (OR 1.21; p = 0.005), and tendon thickness (OR 1.23; p = 0.002).
CONCLUSIONS: The Fowler-Philip angle, PTIA, bump height, and increased tendon thickness were independently associated with IAT and may enhance radiographic diagnosis and structural characterization.
LEVEL OF EVIDENCE: Level III, Retrospective Comparative Study.