{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:25Z","timestamp":1783509325511,"version":"3.55.0"},"reference-count":45,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Flat feet change lower-extremity alignment, and they may change the load distribution on the Achilles tendon during exercise. The purpose of this study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at three points: 1, 2, and 3 cm proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises, which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Achilles tendon thickness at all three points measured was thinner in the flat feet group at preexercise and postexercise conditions compared with that of the control group (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .05). Achilles tendon thickness at all three points decreased after the exercise in both groups (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .001). The differences in Achilles tendon thickness at all three points measured between preexercise and postexercise conditions were lower in individuals with flat feet than in those of the control group (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; .05).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, tendon thickness markedly diminished in individuals with normal foot posture. The findings are thought to result from changes in tendon structure and load distribution on the Achilles tendon.\n                  <\/jats:p>","DOI":"10.7547\/22-230","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T07:36:49Z","timestamp":1693553809000},"source":"Crossref","is-referenced-by-count":1,"title":["Immediate Effect of Cumulative Transverse Strain via Exercise on the Achilles Tendon in Individuals with and Without Flat Feet"],"prefix":"10.3390","volume":"115","author":[{"given":"Serkan","family":"Ta\u015f","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Toros University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat Fatih","family":"Ko\u00e7yi\u011fit","sequence":"additional","affiliation":[{"name":"Department of Therapy and Rehabilitation, Vocational School of Health Services, Alanya Alaaddin Keykubat University, Antalya, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ay\u00e7a","family":"Arac\u0131","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Rehabilitation, Faculty of Health Science, Alanya Alaaddin Keykubat University, Antalya, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed Taha","family":"T\u00fcfek","sequence":"additional","affiliation":[{"name":"Department of Therapy and Rehabilitation, Vocational School of Health Services, Toros University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Phys Ther","first-page":"688","article-title":"Pes cavus and pes planus: analyses and treatment","volume":"67","author":"Franco AH","year":"1987","unstructured":"Franco AH: Pes cavus and pes planus: analyses and treatment. Phys Ther 67: 688, 1987."},{"key":"B2","series-title":"Obes Rev","first-page":"239","article-title":"Musculoskeletal disorders associated with obesity: a biomechanical perspective","volume":"7","author":"Wearing SC","year":"2006","unstructured":"Wearing SC, Hennig EM, Byrne NM, et al: Musculoskeletal disorders associated with obesity: a biomechanical perspective. Obes Rev 7: 239, 2006."},{"key":"B3","series-title":"Br J Sports Med","first-page":"290","article-title":"The foot core system: a new paradigm for understanding intrinsic foot muscle function","volume":"49","author":"McKeon PO","year":"2015","unstructured":"McKeon PO, Hertel J, Bramble D, et al: The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med 49: 290, 2015."},{"key":"B4","series-title":"Clin Podiatr Med Surg","first-page":"59","article-title":"Flexible pediatric and adolescent pes planovalgus: conservative and surgical treatment options","volume":"27","author":"Blitz NM","year":"2010","unstructured":"Blitz NM, Stabile RJ, Giorgini RJ, et al: Flexible pediatric and adolescent pes planovalgus: conservative and surgical treatment options. Clin Podiatr Med Surg 27: 59, 2010."},{"key":"B5","series-title":"J Child Orthop","first-page":"107","article-title":"Flexible flatfoot in children and adolescents","volume":"4","author":"Mosca VS","year":"2010","unstructured":"Mosca VS: Flexible flatfoot in children and adolescents. J Child Orthop 4: 107, 2010."},{"key":"B6","series-title":"Foot (Edinb)","first-page":"83","article-title":"Long-term follow-up of patients undergoing tibialis posterior transfer: is acquired pes planus a complication?","volume":"34","author":"Pecheva M","year":"2018","unstructured":"Pecheva M, Devany A, Nourallah B, et al: Long-term follow-up of patients undergoing tibialis posterior transfer: is acquired pes planus a complication? Foot (Edinb) 34: 83, 2018."},{"key":"B7","series-title":"J Funct Morphol Kinesiol","first-page":"72","article-title":"The biomechanics of pregnancy: a systematic review","volume":"4","author":"Conder R","year":"2019","unstructured":"Conder R, Zamani R, Akrami M: The biomechanics of pregnancy: a systematic review. J Funct Morphol Kinesiol 4: 72, 2019."},{"key":"B8","series-title":"Curr Opin Pediatr","first-page":"93","article-title":"Pediatric flatfoot: cause, epidemiology, assessment, and treatment","volume":"26","author":"Dare DM","year":"2014","unstructured":"Dare DM, Dodwell ER: Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Curr Opin Pediatr 26: 93, 2014."},{"key":"B9","series-title":"Foot (Edinb)","first-page":"81","article-title":"Flatfeet: biomechanical implications, assessment and management","volume":"38","author":"Arachchige SNK","year":"2019","unstructured":"Arachchige SNK, Chander H, Knight A: Flatfeet: biomechanical implications, assessment and management. Foot (Edinb) 38: 81, 2019."},{"key":"B10","series-title":"Int Orthop","first-page":"157","article-title":"Biomechanical analysis of functional adaptation of metatarsal bones in statically deformed feet","volume":"33","author":"Madjarevic M","year":"2009","unstructured":"Madjarevic M, Kolundzic R, Trkulja V, et al: Biomechanical analysis of functional adaptation of metatarsal bones in statically deformed feet. Int Orthop 33: 157, 2009."},{"key":"B11","series-title":"Sports Med","first-page":"585","article-title":"The pathomechanics of plantar fasciitis","volume":"36","author":"Wearing SC","year":"2006","unstructured":"Wearing SC, Smeathers JE, Urry SR, et al: The pathomechanics of plantar fasciitis. Sports Med 36: 585, 2006."},{"key":"B12","series-title":"Folia Med Cracov","first-page":"77","article-title":"Is there a relationship between functional flat foot and prevalence of non-insertional Achilles tendinopathy in joggers? A pilot study","volume":"57","author":"Wnuk-Scardaccione A","year":"2017","unstructured":"Wnuk-Scardaccione A, Mizia E, Rutowicz B, et al: Is there a relationship between functional flat foot and prevalence of non-insertional Achilles tendinopathy in joggers? A pilot study. Folia Med Cracov 57: 77, 2017."},{"key":"B13","series-title":"Scand J Med Sci Sports","first-page":"1970","article-title":"Is Achilles tendon blood flow related to foot pronation?","volume":"27","author":"Wezenbeek E","year":"2017","unstructured":"Wezenbeek E, Willems TM, Mahieu N, et al: Is Achilles tendon blood flow related to foot pronation? Scand J Med Sci Sports 27: 1970, 2017."},{"key":"B14","series-title":"Sports Med","first-page":"173","article-title":"Achilles tendon injuries in athletes","volume":"18","author":"Kvist M","year":"1994","unstructured":"Kvist M: Achilles tendon injuries in athletes. Sports Med 18: 173, 1994."},{"key":"B15","series-title":"Am J Sports Med","first-page":"179","article-title":"Achilles tendinitis and peritendinitis: etiology and treatment","volume":"12","author":"Clement D","year":"1984","unstructured":"Clement D, Taunton J, Smart G: Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 12: 179, 1984."},{"key":"B16","series-title":"Foot Ankle Int","first-page":"1078","article-title":"Hindfoot alignment valgus moment arm increases in adult flatfoot with Achilles tendon contracture","volume":"30","author":"Arangio G","year":"2009","unstructured":"Arangio G, Rogman A, Reed JF: Hindfoot alignment valgus moment arm increases in adult flatfoot with Achilles tendon contracture. Foot Ankle Int 30: 1078, 2009."},{"key":"B17","series-title":"Foot (Edinb)","first-page":"91","article-title":"The effect of foot type on the Achilles tendon moment arm and biomechanics","volume":"38","author":"Deforth M","year":"2019","unstructured":"Deforth M, Zwicky L, Horn T, et al: The effect of foot type on the Achilles tendon moment arm and biomechanics. Foot (Edinb) 38: 91, 2019."},{"key":"B18","series-title":"Scand J Med Sci Sports","first-page":"3","article-title":"Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation","volume":"18","author":"Fredberg U","year":"2008","unstructured":"Fredberg U, Stengaard-Pedersen K: Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 18: 3, 2008."},{"key":"B19","series-title":"Scand J Med Sci Sports","first-page":"535","article-title":"Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon","volume":"24","author":"Murley G","year":"2014","unstructured":"Murley G, Tan J, Edwards R, et al: Foot posture is associated with morphometry of the peroneus longus muscle, tibialis anterior tendon, and Achilles tendon. Scand J Med Sci Sports 24: 535, 2014."},{"key":"B20","series-title":"Diagn Interv Imaging","first-page":"907","article-title":"Ultrasonographic evaluation of Achilles tendon in children with flatfoot: a case-control morphometric study","volume":"97","author":"Gonul Y","year":"2016","unstructured":"Gonul Y, Yucel O, Eroglu M, et al: Ultrasonographic evaluation of Achilles tendon in children with flatfoot: a case-control morphometric study. Diagn Interv Imaging 97: 907, 2016."},{"key":"B21","series-title":"The Impact of Technology on Sport II","first-page":"65","article-title":"The Time-Course of Acute Changes in Achilles Tendon Morphology Following Exercise","author":"Wearing S","year":"2008","unstructured":"Wearing S, Smeathers J, Urry S, et al: \u201cThe Time-Course of Acute Changes in Achilles Tendon Morphology Following Exercise,\u201d in The Impact of Technology on Sport II, edited by FK Fuss, A Subic, S Ujihashi, p 65, Taylor & Francis, New York, 2008."},{"key":"B22","series-title":"J Appl Physiol (1985)","first-page":"1384","article-title":"Conditioning of the Achilles tendon via ankle exercise improves correlations between sonographic measures of tendon thickness and body anthropometry","volume":"110","author":"Wearing SC","year":"2011","unstructured":"Wearing SC, Grigg NL, Hooper SL, et al: Conditioning of the Achilles tendon via ankle exercise improves correlations between sonographic measures of tendon thickness and body anthropometry. 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Muscles Ligaments Tendons J 7: 192, 2017."},{"key":"B35","series-title":"Med Probl Perform Art","first-page":"221","article-title":"Achilles and patellar tendon morphology in dancers with and without tendon pain","volume":"29","author":"Kulig K","year":"2014","unstructured":"Kulig K, Oki KC, Chang YJ, et al: Achilles and patellar tendon morphology in dancers with and without tendon pain. Med Probl Perform Art 29: 221, 2014."},{"key":"B36","series-title":"Gait Posture","first-page":"387","article-title":"Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study","volume":"29","author":"Van Ginckel A","year":"2009","unstructured":"Van Ginckel A, Thijs Y, Hesar NG, et al: Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture 29: 387, 2009."},{"key":"B37","series-title":"J Musculoskelet Neuronal Interact","first-page":"115","article-title":"In vivo investigation of tendon responses to mechanical loading","volume":"11","author":"Heinemeier KM","year":"2011","unstructured":"Heinemeier KM, Kjaer M: In vivo investigation of tendon responses to mechanical loading. J Musculoskelet Neuronal Interact 11: 115, 2011."},{"key":"B38","series-title":"Arthritis Res Ther","first-page":"235","article-title":"Pathogenesis of tendinopathies: inflammation or degeneration?","volume":"11","author":"Abate M","year":"2009","unstructured":"Abate M, Silbernagel KG, Siljeholm C, et al: Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther 11: 235, 2009."},{"key":"B39","series-title":"Eur J Appl Physiol","first-page":"520","article-title":"Gender differences in the viscoelastic properties of tendon structures","volume":"88","author":"Kubo K","year":"2003","unstructured":"Kubo K, Kanehisa H, Fukunaga T: Gender differences in the viscoelastic properties of tendon structures. Eur J Appl Physiol 88: 520, 2003."},{"key":"B40","series-title":"Radiology","first-page":"765","article-title":"Achilles tendon: US diagnosis of pathologic conditions: work in progress","volume":"159","author":"Blei CL","year":"1986","unstructured":"Blei CL, Nirschl RP, Grant EG: Achilles tendon: US diagnosis of pathologic conditions: work in progress. Radiology 159: 765, 1986."},{"key":"B41","series-title":"Injury","first-page":"1267","article-title":"Review of the vascularisation of the human Achilles tendon","volume":"36","author":"Theobald P","year":"2005","unstructured":"Theobald P, Benjamin M, Nokes L: Review of the vascularisation of the human Achilles tendon. Injury 36: 1267, 2005."},{"key":"B42","series-title":"Biomech Model Mechanobiol","first-page":"405","article-title":"A finite element model predicts the mechanotransduction response of tendon cells to cyclic tensile loading","volume":"7","author":"Lavagnino M","year":"2008","unstructured":"Lavagnino M, Arnoczky SP, Kepich E: A finite element model predicts the mechanotransduction response of tendon cells to cyclic tensile loading. 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