Ultrasonographic changes in lower extremity tendon thickness after stroke rehabilitation and their associations with balance and functional outcomes
Year: 2026
Type: article
Abstract: Introduction Peripheral musculoskeletal structures may undergo secondary changes after stroke, but tendon-specific adaptations and their relationship with functional recovery are not well defined. This study examined lower extremity tendon thickness in patients with post-stroke hemiplegia before and after a four-week inpatient rehabilitation program and explored associations between tendon thickness and clinical improvement. Methods In this prospective observational study, 45 patients with post-stroke hemiplegia completed a four-week rehabilitation program. Quadriceps, patellar, Achilles tendon and plantar fascia thicknesses were measured bilaterally at baseline and post-treatment using ultrasonography. Clinical assessments included the Berg Balance Scale (BBS), Functional Ambulation Classification (FAC), Barthel Index, Brunnstrom stages and Modified Ashworth Scale (MAS). Fifteen healthy volunteers served as controls (single assessment). Continuous variables are presented as mean ± SD when approximately normally distributed and as median (IQR) otherwise; p -values were adjusted for multiplicity in secondary analyses as specified. Results Paretic-side quadriceps tendon thickness (primary outcome) increased from 5.94 ± 0.96 to 6.48 ± 0.95 mm ( p < 0.001), with 21/45 (46.7%) exceeding minimal detectable change with a 95% confidence interval (MDC 95 ). Baseline paretic-side quadriceps thickness was lower than controls (p_adj = 0.048) but did not differ post-treatment (p_adj > 0.99). Patellar and Achilles tendons and plantar fascia also showed consistent bilateral increases (all p < 0.001). Balance and functional outcomes improved over the period (BBS Δ : 6 [4–9]; FAC improved by ≥1 level in 27/45 [60.0%]; Barthel improved with median paired Δ : 0 [0–5]; all p < 0.001). Changes in quadriceps tendon thickness showed modest positive associations with changes in BBS (both sides) and Barthel (non-paretic side). Discussion Lower-extremity tendon morphology in post-stroke hemiplegia appeared dynamic over a 4-week inpatient rehabilitation period, with quadriceps tendon thickness broadly paralleling improvements in balance and functional independence. Larger, longer-term studies are needed to clarify clinical utility.
Source: Frontiers in Neurology
Authors: Tugba Alisik, Ebubekir Demir
Institution: Bolu Abant İzzet Baysal University
Language: English
Subfield: Rehabilitation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7129260641