Tendinopathic plantaris but normal Achilles tendon found in about one-fifth of patients not responding to conservative Achilles tendon management – results from a prospective WALANT surgical case series on 105 tendons

Review written by Dr Melinda Smith info

Key Points

  1. In patients with persistent Achilles tendon pain, who had not responded to typical conservative management, almost one in five were found to have plantaris tendinopathy with a normal Achilles tendon.
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BACKGROUND & OBJECTIVE

The plantaris muscle is part of the posterior superficial compartment of the lower leg. It originates on the postero-superior aspect of the lateral supracondylar ridge of the femur as a small fusiform muscle belly and develops into a long thin tendon that descends the leg between the gastrocnemius and soleus to insert into the calcaneus or Achilles tendon (1).

The plantaris tendon lays parallel to the Achilles tendon on its medial side and is enveloped in the same peritendinous tissue as the Achilles tendon (1). Plantaris involvement / coexisting plantaris tendinopathy in a subset of midportion Achilles tendinopathy has been well described in the literature, but a small case series suggests that plantaris tendinopathy alone may be a cause of pain in the region of the Achilles midportion (2).

The aim of this study was to investigate the frequency of plantaris tendinopathy, but a normal Achilles tendon, in patients referred to a specialized tendon clinic for midportion Achilles tendon pain not responding to conservative treatment.

The plantaris tendon lays parallel to the Achilles tendon on its medial side and is enveloped in the same peritendinous tissue as the Achilles tendon.
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In patients with persistent Achilles tendon pain who had not responded to typical conservative management, almost one in five were found to have plantaris tendinopathy with a normal Achilles tendon.

METHODS

  • Patients with persistent painful midportion Achilles tendon pain who presented to the Alfredson Tendon Clinic in Sweden between August 2020 and November 2023 were included.
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