Objective To report the intra- and inter-operator reliability of ultrasound strain elastography measures in the assessment of quadriceps and patellar tendons. Materials and methods Forty tendons were investigated of 20 healthy volunteers. Five anatomical sites were examined and analysed by three operators of differing levels of experience. Ultrasound was performed over two measures, employing three sonoelastography measurement techniques using a GE S8 with linear probe (L6–15 MHz). The percentage of exact agreement, Cohen's kappa and ICC2,1 were performed to assess intra- and inter-operator reliability. Results The patellar tendon is more reliably measured across all techniques compared to the quadriceps tendon, particularly the distal region. Colour scoring was the most reliable method of sonoelastography. Colour scoring intra- and inter-operator reliability was better for patella tendon sites across all operators (60–95% agreement range), and greatest for experienced operators. Elasticity index intra-operator reliability was greatest for the most experienced operator compared with the least (ICC range 0.35–0.72 and ICC 0.17–0.60). Elasticity ratio intra-operator reliability of the patella tendon was fair–excellent for the experienced operator (ICC range 0.43–0.91), excluding the mid patellar region (ICC 0.13). Poor–fair inter-operator reliability was observed for elasticity ratio (ICC range 0.0–0.54) and elasticity index (ICC range 0.0–0.57). Conclusions Strain elastography of the patellar tendon is more reliable than the quadriceps tendon. Intra- and inter-operator reliability was better when undertaken by more experienced operators. Colour scoring was more reliable than elasticity ratio and index methods. Poor–fair intra- and inter-operator reliability of the elasticity ratio and elasticity index was observed.

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Just over half the patients in this present cohort may be physically able to undertake some aspects of self-managed foot care, including nail clipping and filing, callus filing and daily hygiene and inspection.

Background Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. Methods In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. Results A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). Conclusions This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.

Background/Aims Emerging evidence suggests musculoskeletal ultrasound (MSUS) may benefit patient understanding of their inflammatory arthritis and medication adherence. The overall objective was to explore patient perceptions of MSUS when used as a patient education tool in relation to foot problems in people with rheumatic and musculoskeletal diseases (RMD). Methods Consecutive patients attending a rheumatology podiatry clinic at the Queen Elizabeth University Hospital Podiatry Department, Glasgow, were invited to participate. To gather information on how useful MSUS was for patient understanding of their foot problems, participants completed a brief questionnaire before and after their MSUS scan. MSUS assessment of affected foot structures was conducted by a single podiatrist with MSUS training (LN) using an Esaote MyLabAlpha portable US machine. Participants were shown both grayscale and power Doppler MSUS still images with/without video clips and caliper measurements depending on the presenting complaint. Anatomical foot models were used to orientate patients to foot anatomy and corresponding MSUS images. Results A total of 43 (12 male: 31 female) participants were recruited with a mean (SD) age of 50 (12) years and median disease duration (IQR) of 6 (1,10) years. The most common RMD was spondylarthopathy (30%) followed by RA (23%). In this group, the rearfoot region (35%) was most frequently involved. The most frequently affected structure was tendons (30%) with multiple structures affected in 19%. A range of mechanical and inflammatory MSUS diagnoses were made. 56% of participants had not previously seen MSUS of the joints or tendons, with the remaining 44% unsure. 93% reported the MSUS scan improved understanding of their foot pain and 98% reported it will make them more likely to adhere to podiatry treatments and advice [Table 1]. 98% also reported that MSUS was more useful than other educational resources for understanding their foot pain. Still images were selected most frequently as the method that made the most sense to participants. Conclusion This study provides preliminary evidence of the potential value of MSUS as an educational tool in podiatry, with potential to enhance adherence with podiatry interventions and rehabilitation programmes. Further work using a follow up design is required. Disclosure L. Newcombe: None. J. Tougher: None. N. Kelleher: None. J. Woodburn: None. R. Barn: None.