Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 22;7(1):e000979.
doi: 10.1136/bmjsem-2020-000979. eCollection 2021.

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

Håkan Alfredson  1   2 , Lorenzo Masci  3 , Christoph Spang  4   5
Affiliations

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

Håkan Alfredson et al. BMJ Open Sport Exerc Med. .

Abstract

Objectives: Chronic 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.

Methods: Ninety-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.

Results: In 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.

Conclusion: Plantaris 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 evidence: IV case series.

Keywords: achilles; ankle; surgery; tendinopathy; tendinosis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Surgical removal of a thickened and widened plantaris tendon on the medial side of the Achilles insertion. The plantaris is identified proximally, released and followed all the way down to the insertion, where the tendon is divided.
Figure 2
Figure 2
Ultrasound image showing a widened plantaris tendon (arrow) is seen on the medial side of the Achilles insertion.
See this image and copyright information in PMC

References

    1. Myerson MS, McGarvey W. Disorders of the insertion of the Achilles tendon and Achilles tendinitis. J Bone Joint Surg Am 1998;80A:1814–24.
    1. Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, et al. Treatment for insertional Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2013;21:1345–55. 10.1007/s00167-012-2219-8 - DOI - PubMed
    1. Andersson G, Backman LJ, Christensen J, et al. Nerve distributions in insertional Achilles tendinopathy - a comparison of bone, bursae and tendon. Histol Histopathol 2017;32:263–70. 2017. 10.14670/HH-11-790 - DOI - PubMed
    1. Alfredson H, Spang C. Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone-a case series. BMJ Open Sport Exerc Med 2020;6:e000769. 10.1136/bmjsem-2020-000769 - DOI - PMC - PubMed
    1. Dilger CP, Chimenti RL. Nonsurgical treatment options for insertional Achilles tendinopathy. Foot Ankle Clin 2019;24:505–13. 10.1016/j.fcl.2019.04.004 - DOI - PMC - PubMed