Article Text
Abstract
Objectives Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.
Methods Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.
Results In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.
Conclusion Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.
Level of evidence IV case series.
- achilles
- tendinopathy
- tendinosis
- surgery
- ankle
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Footnotes
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Contributors HA performed all the surgeries and clinical examinations. CS was involved in the data processing. LM was involved in clinical examination and ultrasound imaging. All authors were involved in the design of the study, the 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 surgical treatment of Achilles tendinopathy were approved by a local ethics committee (Umea University, Sweden).
Provenance and peer review Not commissioned; externally peer reviewed.