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The Effect of the Plantaris Tendon on Achilles Tendinopathy

Authors

Stefan Wever, Jarrod Antflick & James Calder 

Publisher

The Achilles Tendon Pathology, Treatment and Rehabilitation, 2023-pp 23–31

Publishing detail

LINK

Abstract

Knowledge regarding the plantaris tendon and its involvement in midportion Achilles tendinopathy has evolved over the last decade. Various mechanisms have been proposed, including mechanical frictional syndrome, insertional variations with differential traction, and intrinsic tendon factors, as causes of midportion Achilles tendinopathy.

A thorough understanding of its anatomy, function, and clinical presentation is important to manage plantaris-related pathology. Ultrasound tissue characterisation (UTC) scans can visualise and quantify the structure of the Achilles tendon and detect a plantaris tendon located close to the medial border of the Achilles.

The mainstay of treatment is conservative, including relative unloading, modification of training regimes and specific exercises. Heavy slow resistance (HSR) training compared to eccentric exercises has shown higher patient satisfaction rates and compliance.

Image-guided injections targeting the interface between the plantaris and the Achilles tendon are useful for recalcitrant cases with a small proportion requiring surgery. Various methods, including ultrasound-guided, endoscopic, minimal open and formal open procedures, have been described with good clinical outcomes.

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