Background/Purpose: Insertional and midportion Achilles tendinopathy (AT) are painful injuries affecting both active and sedentary populations. Patients with AT present with pain with loading, often reporting pain with walking. Compared to midportion AT, insertional AT is more frequently associated with pain in positions of dorsiflexion, experienced during walking, due to compression of the distal tendon on the calcaneus. It is unknown however, if differences exist in gait spatiotemporal measures between AT subtypes and further, if these measures relate to pain. Therefore, the purpose of this analysis is to compare spatiotemporal measures of gait between patients with midportion AT and patients with insertional AT. We also aimed to assess the relationship between pain and spatiotemporal measures within each subtype.

Methods: Patients with insertional AT and midportion AT ambulated at their self-selected pace for 10m. Gait speed and percent of time spent in swing, stance, load response, flat foot, and pre-swing on the most symptomatic limb were measured with inertial measurement units (MuscleLab). Patient Reported Outcomes Measurement Information System (PROMIS) pain interference was used to assess pain. Independent t-tests were used to assess for differences in outcome variables between AT subtypes. Pearson correlations were used to assess for relationship between PROMIS pain interference and gait measures in patients with insertional AT and patients with midportion AT.

Results: 42 patients with insertional AT (24 F; 51.8±9 years; 32.4±7 kg/m²) and 178 patients with midportion AT (100 F; 47.1±13 years; 28.7±6 kg/m²) were included. No significant differences were observed between AT subtypes in any gait spatiotemporal measures or PROMIS pain interference (p >0.05). In patients with midportion AT, there was a significant negative relationship between PROMIS pain interference and gait speed (r=-0.153, p=0.048) but no significant relationship with all other gait measures (p’s >0.05). In patients with insertional AT, there was a significant negative relationship between PROMIS pain interference and gait speed (r=-0.387, p=0.012) and a significant negative relationship between PROMIS pain interference and percent time in load response phase (r=-0.489, p< 0.001). There were no other significant relationships with remaining analysis in patients with insertional AT.

Conclusion: No differences were observed between gait parameters or pain interference between AT subtypes. In patients with midportion AT, increased pain interference was weakly correlated with slower gait speed. The same pattern was observed in patients with insertional AT, however, the relationship was moderate between increased pain interference and reduced gait speed. Further, in patients with insertional AT, increased pain interference was moderately related to percent of time in the load response phase. Therefore, gait in patients with insertional AT may be more associated with pain than in midportion AT.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-gait-spatiotemporal-measures-between-patients-with-insertional-achilles-tendinopathy-or-midportion-achilles-tendinopathy/