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

Abstract

ObjectivesChronic 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.MethodsNinety-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.ResultsIn 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.ConclusionPlantaris 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 evidenceIV case series.

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

“…Recent research has demonstrated that plantaris tendon involvement can be found in patients with chronic midportion and insertional Achilles tendon tendinopathy, especially when there is medial Achilles tendon pain [ 19 , 34 , 35 , 36 ]. Cadaveric studies have demonstrated that there is an individual variability of the course of the plantaris tendon in relation to the Achilles tendon, with up to nine different courses demonstrated [ 17 ].…”

“…As exercise approaches so far have not been successful for the treatment of patients with diagnosed plantaris tendon involvement, it seems that surgical intervention is needed to allow for a return to pain-free Achilles tendon loading in this sub-group. As such, recent studies have begun to explore better diagnostic strategies and use less invasive ultrasound-guided percutaneous surgical treatments [ 19 , 35 , 41 , 42 ].…”

Actualización científica en ecografía y tendinopatía aquilea. Implicaciones anatómicas relacionadas, abordaje terapéutico y nuevas perspectivas basadas en la evidencia

“…También cabe mencionar algunas otras patologías que tienen una estrecha relación con el tendón de Aquiles, como las bursitis (preaquílea y retrocalcánea), la enfermedad de Sever (en pacientes en etapas de crecimiento) y la deformidad de Haglund. Incluso podemos añadir la tendinopatía del músculo plantar como un posible origen de dolor en la región del tendón de Aquiles 17,18 . También hay que tener en cuenta la inervación sensorial del tendón de Aquiles, a través del nervio sural, como posible fuente de dolor en la región posterior del tobillo, sin necesidad de que exista una afectación estructural del propio tendón 19 .…”

Quantitative shear wave elastography compared to standard ultrasound (qualitative B-mode grayscale sonography and quantitative power Doppler) for evaluation of achillotendinopathy in treatment-naïve individuals: A cross-sectional study

“…The diagnosis of tendinopathy is not always easy using imaging modalities 5 because 3 different muscles contribute to the Achilles tendons. 6 The B-mode grayscale sonography and power Doppler are well-established ultrasound techniques, and magnetic resonance imaging (MRI) is used to visualize tendon structure 7 because heterogeneous echogenicity or hypoechogenicity and increased tendon thickness correlates with tendon functions. 8 However, their utilization in Achilles tendinopathy diagnosis is controversial 9 because their sensitivity is limited and Achilles tendinopathy lacks conventional sonographic characters in symptomatic patients.…”