Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon: a case series

Abstract

ObjectivesSurgical 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 settingProspective case series study at one centre.ParticipantsTen 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.InterventionsOperative treatment consisting of ultrasound-guided excision of the plantaris tendon.Primary and secondary outcome measuresScores 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.ResultsThe 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 activityConclusionThe 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.

Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

“…This highlights the possibility that the plantaris and its surrounding tissues may indeed be a pain driver in patients with medial Achilles tenderness. 14 The results of the current study show that for proper decision making on suitable treatments, the potential involvement of the plantaris tendon should be examined.…”

“…17 18 Furthermore, there is evidence that in some cases, only the plantaris tendon is abnormal suggesting that the plantaris tendon itself can be a driver of medial Achilles tendon pain. 14 Open access the plantaris and Achilles, and tendinopathic structural changes in the medial side of the Achilles. 7 For chronic painful insertional Achilles tendinopathy there is, to the best of our knowledge, no study that has evaluated the position and impact of the plantaris tendon.…”

“… 17 18 Furthermore, there is evidence that in some cases, only the plantaris tendon is abnormal suggesting that the plantaris tendon itself can be a driver of medial Achilles tendon pain. 14 Therefore, a proper diagnosis including evaluation of plantaris tendon involvement is essential for choosing the correct treatment. Studies comparing clinical, surgical and imaging findings in patients with mid-portion Achilles tendinopathy have shown that plantaris tendon involvement is mostly characterised by medial tenderness, localised high blood flow between the plantaris and Achilles, and tendinopathic structural changes in the medial side of the Achilles.…”

Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

“…However, for plantaris-tendon-related pain the symptoms most often subside within a couple of days and then return during explosive plantar and dorsiflexion activities. Plantaris tendon involvement can be diagnosed using ultrasound [ 33 , 34 , 35 ].…”

Achilles Scraping and Plantaris Tendon Removal Improves Pain and Tendon Structure in Patients with Mid-Portion Achilles Tendinopathy—A 24 Month Follow-Up Case Series

“…It is likely that different pathways can play a role in a certain sub-group of patients. In a recent study, it was demonstrated that in some patients with medial Achilles pain there is plantaris tendinopathy alone together with a structurally normal Achilles tendon [ 40 ]. Furthermore, histological studies have demonstrated comparably high degrees of sensory innervation within the plantaris tendon, highlighting its potential role as a pain mediator [ 21 ].…”