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Clinical factors that predict ultrasound alterations in Achilles tendon in professional ballet dancers: A nonlinear analysis.


Achilles tendinopathy is characterized by persistent tendon pain and loss of function related to mechanical load. In classical ballet, the incidence of AT is 19% among all injuries. In this pathology, morphological changes (hypoechoic areas and tendon thickening) are observed by ultrasonography. However, these changes may also be present in asymptomatic individuals, making them more susceptible to the development of symptoms. The interaction of factors such as excessive subtalar pronation, limitation of ankle dorsiflexion range of motion, as well as lower limb strength and endurance muscle deficits can produce excessive loads on the Achilles tendon and thus cause the morphological changes previously mentioned. To our knowledge, however, no study has investigated the association between clinical measures and sonographic changes in the Achilles tendon of professional dancers. The objectives of the study are to verify, through a nonlinear analysis, which of these factors are associated with the presence of hypoechoic areas and the Achilles tendon thickness of professional dancers, as well as how they interact to predict these morphological changes. This study will use a cross-sectional design. Will be included in the study healthy professional ballet dancers, 18 to 40 years old, both genders. All participants will undergo: 1- morphological evaluation of the Achilles tendon; 2- evaluation of subtalar joint alignment; 3- evaluation of ankle dorsiflexion range of motion; 4- evaluation of the maximal isometric torque of the hip, knee and ankle; and 5- evaluation of the endurance of the ankle plantar flexor muscles. The association between clinical and ultrasound variables will be analyzed using the Classification and Regression Trees (CART). (AU)

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