A Radiographic Study of Biomechanical Relationship between the Achilles Tendon and Plantar Fascia

Abstract

Background. Previously, scholars have concluded that the Achilles tendon and the plantar fascia were closely biomechanically related, although there is little clinical evidence of the relationship between the two. To investigate the biomechanical relationship between the Achilles tendon and the plantar fascia, the author used standing lateral ankle radiographs of patients with insertional Achilles tendonitis to determine the biomechanical relationship between the Achilles tendon and plantar fascia. Methods. The author collected standing lateral ankle radiographs from patients with insertional Achilles tendonitis who accepted surgical treatment in the author’s hospital from March 2009 to July 2018. According to whether there were bone spurs on the posterior side of the calcaneus, patients were divided into group A (spur present on the posterior side) and group B (spur not present on the posterior side). The positive rates of spurs on the plantar side of the calcaneus were determined in group A and group B. The chi-square test was used to compare the measurement results between the two groups. Results. In group A, 13 heels were positive for calcaneal bone spurs, and the positive rate was 65.0%. In group B, 3 heels were positive for plantar calcaneal spurs, and the positive rate was 12%. Among all 16 patients with positive plantar calcaneal spurs, 13 had posterior calcaneal spurs (accounting for 81.3%), and 3 had negative results, accounting for 18.7%. There was a significant difference between the results in groups A and B (P<0.05). Conclusion. There is a relationship between posterior calcaneal spurs and plantar calcaneal spurs in patients with insertional Achilles tendonitis, which can be inferred as resulting from the increasing tension in the biomechanically complex relationship between the Achilles tendon and the plantar fascia.

Why heel spurs are traction spurs after all

“…Therefore, these spurs reveal a close morphological relationship with the plantar fascia, which most likely stimulates their growth caused by traction forces. Secondly, this study highlighted the fact www.nature.com/scientificreports/ that spurs form complex three-dimensional structures, which were so far most commonly assessed using twodimensional images both clinically 3,4,7,19,[25][26][27][28][29] and in research 2,10,14,16 . Hence, the enthesis of the plantar fascia in superiorly located spurs can easily be missed, leading to the assumption that the spurs do not develop as a result of external traction forces 9,14 .…”

“…This impairs a direct comparison between these observations. Several authors have suggested considering the Achilles tendon, the calcaneus and the plantar fascia as a functional entity, and including the plantar region in the treatment of Achilles tendon pathologies and vice versa [17][18][19][20][21] . The former is supported by the finding that thick collagen fibres are connecting the Achilles tendon and the plantar fascia via the calcaneus in neonates, forming an apophyseal area, which is ossifying throughout life and leaves only the insertions of the soft tissues into the calcaneus 18 .…”

Characteristics of Pressure on the Apophysis in the Course of Paediatric Heel Pain—Preliminary Report

“…The analysis of the results showed that both the forward tilt of the posture and the observed defects and dysfunctions of the feet can cause the formation of traction forces within the heel apophysis. Lack of heel load and shifting the body weight forward (during standing and walking) causes tension of the plantar flexors of the feet and eccentric tension within the Achilles tendon [ 119 , 120 ]. Thus, through the action of internal forces, i.e., in the course of the plantar structures of the feet to the front of the foot and upwards in the course of the Achilles tendon, this causes pressure on the heel bone, lifting the heel and stretching in opposite directions.…”

Association of Obesity and Plantar Fasciitis in Patients With Plantar Heel Spurs

“…Several radiographic studies reported a relationship between posterior heel spur and plantar heel spur. 30 , 34 Posterior heel spur has been postulated to occur from repetitive traction of the Achilles tendon at the insertion of the calcaneus, resulting in subsequent inflammation and spur formation. Zhu et al in their radiographic study demonstrated the relationship between posterior and plantar heel spurs in patients with insertional Achilles tendonitis.…”

“…They explained this relationship by the increasing tension in the biomechanical complex involving the Achilles tendon, calcaneus, and plantar fascia. 34 In contrast, other authors contend that plantar heel spurs are fundamentally different from posterior heel spurs in the Achilles tendon, citing anatomic investigations that report plantar heel spurs have vertically oriented trabecula rather than horizontally oriented trabecula. 15 , 18 They suggest that calcaneal spurs are fibrocartilaginous outgrowths formed in response to calcaneal stress fractures, which is to protect the calcaneus against microcracks.…”