The anatomical footprint of the Achilles tendon

Abstract

We dissected 12 fresh-frozen leg specimens to identify the insertional footprint of each fascicle of the Achilles tendon on the calcaneum in relation to their corresponding muscles. A further ten embalmed specimens were examined to confirm an observation on the retrocalcaneal bursa. The superficial part of the insertion of the Achilles tendon is represented by fascicles from the medial head of the gastrocnemius muscle, which is inserted over the entire width of the inferior facet of the calcaneal tuberosity. In three specimens this insertion was in continuity with the plantar fascia in the form of periosteum. The deep part of the insertion of the Achilles tendon is made of fascicles from the soleus tendon, which insert on the medial aspect of the middle facet of the calcaneal tuberosity, while the fascicles of the lateral head of the gastrocnemius tendon insert on the lateral aspect of the middle facet of the calcaneal tuberosity. A bicameral retrocalcaneal bursa was present in 15 of the 22 examined specimens. This new observation and description of the insertional footprint of the Achilles tendon and the retrocalcaneal bursa may allow a better understanding of the function of each muscular part of the gastrosoleus complex. This may have clinical relevance in the treatment of Achilles tendinopathies.

The twisted structure of the Achilles tendon unraveled: A detailed quantitative and qualitative anatomical investigation

“…The latter is composed of two heads-the lateral head of gastrocnemius muscle (GL) and the medial head of gastrocnemius muscle (GM), from each of which originates an independent subtendon. [1][2][3][4][5][6][7][8] In 65% of the population, the plantaris tendon also contributes to the AT. 8 Proximally, the AT fibers join the triceps surae's muscle fibers at the level of musculo-tendinous junction.…”

“…[2][3][4]7,9 The AT inserts distally into the superior, middle, and inferior facets of the calcaneal tuberosity, and the width of its insertion varies from 20 to 48 mm. 1,[10][11][12][13] The twisted descending structure of the AT enables it to handle the functional loads applied to the tendon. The differences in the degree of torsion may in turn contribute to mechanisms of AT injury or may in part explain increased susceptibility to AT injury in certain individuals.…”

“…17 Furthermore, several common surgical procedures in practice (e.g., excision of a prominent superior calcaneal tuberosity) require temporary detachment of the AT from its insertional point on the calcaneal bone, and thus, detailed knowledge of the anatomical characteristics of this region is a must for the operating surgeon. 1 While previous studies have determined various parameters of the AT, to the best knowledge of the authors, there is no study presenting a complete anatomical description of the AT, its twisted, structure, individual subtendons, and the relationships between them. [2][3][4]7,9 Two earlier studies have presented information regarding the angle of AT torsion.…”

Comparison of the efficacy of three isolated gastrocnemius recession procedures in a cadaveric model of gastrocnemius tightness

“…Compared with the lateral head of the gastrocnemius, the medial head is wider, thicker and tighter, and with less complicated and variable neurovascular structures nearby [18,21]. A recent anatomic study revealed that the superficial part of the Achilles tendon is mainly from the medial head of the gastrocnemius and has continuity with the plantar fascia [22]. Only releasing the medial head may safely achieve a relatively satisfactory correction of the contracture [10,23,24].…”

The Double-Row Suture Technique: A Better Option for the Treatment of Haglund Syndrome

“…After excision the calcified and the inflamed tendon, a suture anchor was used to reattach and repair the Achilles tendon [15]. However, the results of this operation were not always satisfactory.…”