Ultrasonographic Evaluation of Achilles Tendon Thickness in the Emergency Department: A Novel Measurement Method

Objective: Increased Achilles tendon thickness is associated with hypercholesterolemia and cardiovascular disease, and ultrasonography is the preferred method for its assessment. This study aimed to evaluate the agreement between Achilles tendon ultrasonographic measurements obtained in different supine positions and those acquired using the standard prone technique.Materials and Methods: This prospective methodological study included 180 healthy adults (70 women, 110 men), representing 360 Achilles tendons. Individuals with systemic disease, regular medication use, or Achilles tendon pathology were excluded. Tendon thickness, width, and cross-sectional area were measured ultrasonographically using four positioning techniques: the conventional prone position (Method 1) and three supine alternatives: leg extended beyond the examination table (Method 2), ankle over the contralateral knee (Method 3), and hip and knee flexed at 90° (Method 4). Measurements were obtained 2 cm proximal to the calcaneal insertion.Results: No significant differences were found between Method 1 and Method 2 for tendon thickness, width, or cross-sectional area (For all parameters; p>0.05). Strong correlations were observed for thickness and cross-sectional area (r>0.8), while width showed a moderate correlation (r=0.6-0.8).Conclusion: Method 2 demonstrated good agreement with the standard prone technique and may serve as a practical alternative for Achilles tendon ultrasonography, particularly when prone positioning is not feasible. This approach may facilitate cardiovascular risk assessment using Achilles tendon thickness in a wider range of clinical settings.