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Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon: a case series
  1. Håkan Alfredson1,2,3,
  2. Lorenzo Masci3,
  3. Christoph Spang4
  1. 1 Sports Medicine Unit, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
  2. 2 ISEH, UCLH, London, UK
  3. 3 Pure Sports Medicine Clinic, London, UK
  4. 4 Anatomy Section, Department of Integrative Medical Biology, Umea University, Umeå, Sweden
  1. Correspondence to Mr Christoph Spang; Christoph.Spang{at}umu.se

Abstract

Objectives Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.

Design and setting Prospective case series study at one centre.

Participants Ten consecutive patients (9 men and one woman, mean age 35 years, range 19–67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon.

Interventions Operative treatment consisting of ultrasound-guided excision of the plantaris tendon.

Primary and secondary outcome measures Scores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.

Results The VISA-A scores increased from 61 (range 45–81) preoperatively to 97 (range 94–100) postoperatively (p<0.01). Follow-up results at 10 months (range 7–72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activity

Conclusion The plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.

  • tendinopathy
  • surgery
  • Achilles
  • tendinosis
  • plantaris tendon

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Footnotes

  • Contributors HA performed all surgeries and clinical examinations. CS performed the data analysis and wrote main parts of the manuscript. LM has contributed considerably to patient recruitment and manuscript writing. All authors were involved in the design of the study, data collection and manuscript writing. The manuscript was finally approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Studies on Achilles and plantaris tendinopathy were approved by the local ethics committee (Umea University, Sweden).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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