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Ryskalin L, Fulceri F, Morucci G, Busoni F, Soldani P, Gesi M. Ultrasonographic measurements of gastro-soleus fascia thickness in midportion Achilles tendinopathy: A case-control study. Ann Anat 2024; 256:152321. [PMID: 39186962 DOI: 10.1016/j.aanat.2024.152321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/25/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND The Achilles tendon is one of the thickest, largest, and strongest tendons in the human body. Biomechanically, the AT represents the conjoint tendon of the triceps surae muscle, placed in series with the plantar fascia (PF) to ensure force transmission from the triceps surae toward the toes during walking, running, and jumping. Commonly encountered in the diagnostic evaluation of heel pain, Achilles tendinopathy (AT) refers to a combination of pathological changes affecting the tendon itself often resulting from excessive repetitive stress and overuse. Nevertheless, increasing evidence demonstrates that structural alterations due to overuse or abnormal patterns of skeletal muscle activity are not necessarily restricted to the muscles or tendons but can also affect the fascial tissue. At the same time, there has been recent discussion regarding the role of the fascial tissue as a potential contributor to the pathophysiological mechanisms of the development of several musculoskeletal disorders including tendinopathies. To the best of our knowledge, ultrasound (US) imaging studies on the fascial structures related to the triceps surae complex, as well as their possible correlation with Achillodynia have never been presented in the current literature. METHODS In the present study, a comparative US imaging evaluation of textural features of the suro-Achilleo-plantar complex was performed in 14 healthy controls and 14 symptomatic subjects complaining of midportion AT. The thickness of the Achilles tendon, paratenon, intermuscular fascia, and PF has been assessed with US. In addition, both groups underwent the Victorian Institute of Sport Assessment-Achilles (VISA-A), a disease-specific questionnaire that measures the severity of symptoms of AT. Correlations between quantitative ultrasound measures and VISA-A scores were determined through Pearson or Spearman's rho correlations. RESULTS Our ultrasonographic findings revealed statistically significant differences (p<0.05) in Achilles tendon and paratenon thicknesses between AT patients and controls. No significant differences were observed between groups in PF at the calcaneal insertion as all mean measures were within the expected range of a normal PF on US imaging. In contrast, in tendinopathic subjects, the deep intermuscular fascia between medial gastrocnemius (MG) and soleus (SOL) muscles is significantly (p<0.01) and considerably thickened compared to those of healthy subjects. Moderate correlations exist between tendon and paratenon thicknesses (r= 0.54, p= 0.04) and between MG-SOL fascia and tendon thicknesses (r= 0.58, p= 0.03). Regarding symptom severity and US morphological findings, the Spearman ρ test showed no correlation. CONCLUSIONS Our data demonstrate that, in symptomatic subjects, US alterations are not restricted to paratenon and intratendinous areas, but also affect upstream structures along the myofascial chain, resulting in thickening of the fascia interposed between MG and SOL muscles. Moreover, positive correlations were found between MG-SOL fascia thickening and abnormalities in AT, paratenon, and symptom severity. Thus, US alterations in the fascial system should be interpreted within the clinical context of patients with AT as they may in turn represent important predictors of subsequent clinical outcomes and could help healthcare professionals and clinicians to refine non-operative treatment strategies and rehabilitation protocols for this disease.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | - Federica Fulceri
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy.
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | | | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma 55, Pisa 56126, Italy; Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa 56121, Italy.
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Ryskalin L, Morucci G, Soldani P, Gesi M. Do the fasciae of the soleus have a role in plantar fasciitis? Clin Anat 2024; 37:413-424. [PMID: 37539773 DOI: 10.1002/ca.24102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 07/16/2023] [Indexed: 08/05/2023]
Abstract
Plantar fasciitis is a chronic, self-limiting, and painful disabling condition affecting the inferomedial aspect of the heel, usually extending toward the metatarsophalangeal joints. There is compelling evidence for a strong correlation between Achilles tendon (AT) loading and plantar aponeurosis (PA) tension. In line with this, tightness of the AT is found in almost 80% of patients affected by plantar fasciitis. A positive correlation has also been reported between gastrocnemius-soleus tightness and heel pain severity in this condition. Despite its high prevalence, the exact etiology and pathological mechanisms underlying plantar heel pain remain unclear. Therefore, the aim of the present paper is to discuss the anatomical and biomechanical substrates of plantar fasciitis with special emphasis on the emerging, though largely neglected, fascial system. In particular, the relationship between the fascia, triceps surae muscle, AT, and PA will be analyzed. We then proceed to discuss how structural and biomechanical alterations of the muscle-tendon-fascia complex due to muscle overuse or injury can create the conditions for the onset of PA pathology. A deeper knowledge of the possible molecular mechanisms underpinning changes in the mechanical properties of the fascial system in response to altered loading and/or muscle contraction could help healthcare professionals and clinicians refine nonoperative treatment strategies and rehabilitation protocols for plantar fasciitis.
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Affiliation(s)
- Larisa Ryskalin
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Gabriele Morucci
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Paola Soldani
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
| | - Marco Gesi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa, Pisa, Italy
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Flores DV, Goes PK, Damer A, Huang BK. The Heel Complex: Anatomy, Imaging, Pathologic Conditions, and Treatment. Radiographics 2024; 44:e230163. [PMID: 38512730 DOI: 10.1148/rg.230163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
The differential diagnosis for heel pain is broad but primarily involves abnormalities of the Achilles tendon, calcaneus, and plantar fascia. Achilles tendon disorders include tendinosis, tendinitis, and partial or complete tears. Tendinosis refers to tendon degeneration, while tendinitis is inflammation after acute overload. Untreated tendinosis can progress to partial or complete tears. Tendon disorders can be accompanied by paratenonitis or inflammation of the loose sheath enclosing the tendon. Initial management involves rehabilitation and image-guided procedures. Operative management is reserved for tendon tears and includes direct repair, tendon transfer, and graft reconstruction. The calcaneus is the most commonly fractured tarsal bone. The majority of fractures are intra-articular; extra-articular fractures, stress or insufficiency fractures, medial process avulsion, and neuropathic avulsion can also occur. Posterosuperior calcaneal exostosis or Haglund deformity, retrocalcaneal bursitis, and insertional Achilles tendinosis form the characteristic triad of Haglund syndrome. It is initially managed with orthotics and physiotherapy. Operative management aims to correct osseous or soft-tissue derangements. The plantar fascia is a strong fibrous tissue that invests the sole of the foot and contributes to midfoot stability. Inflammation or plantar fasciitis is the most common cause of heel pain and can be related to overuse or mechanical causes. Acute rupture is less common but can occur in preexisting plantar fasciitis. Conservative treatment includes footwear modification, calf stretches, and percutaneous procedures. The main operative treatment is plantar fasciotomy. Plantar fibromatosis is a benign fibroblastic proliferation within the fascia that can be locally aggressive and is prone to recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Dyan V Flores
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Paola Kuenzer Goes
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Alameen Damer
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
| | - Brady K Huang
- From the Department of Radiology, Radiation Oncology, and Medical Physics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada (D.V.F., A.D.); Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6 (D.V.F.); Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.V.F.); Division of Musculoskeletal Radiology, Laboratorio Delboni Auriemo, DASA, São Paulo, Brazil (P.K.G.); and Division of Musculoskeletal Imaging and Intervention, Department of Radiology, University of California San Diego Medical Center, San Diego, Calif (B.K.H.)
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SHIOTANI HIROTO, TAKAHASHI KATSUKI, HONMA YUKI, TOMARI KAZUKI, HAYASHI HIDETAKA, SADO NATSUKI, KAWAKAMI YASUO. Mechanical Linkage between Achilles Tendon and Plantar Fascia Accounts for Range of Motion of Human Ankle-Foot Complex. Med Sci Sports Exerc 2023; 55:66-73. [PMID: 35977106 PMCID: PMC9770132 DOI: 10.1249/mss.0000000000003020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The human ankle-foot complex possesses a passive range of motion (ROM) through changes in tibiocalcaneal ( θcal ) and foot arch ( θarch ) angles. Based on the anatomical linkage between the Achilles tendon (AT) and plantar fascia (PF), we hypothesized that AT and PF with different mechanical properties conjointly modulate the passive ROM of the human ankle-foot complex. We examined the association of AT and PF stiffness with passive ankle-foot ROM and further addressed differences between sexes. METHODS A series of sagittal magnetic resonance images of the foot and passive ankle plantar flexion torque were obtained for 20 men and 20 women with their ankle-foot passively rotated from 30° of plantar flexion to 20° of dorsiflexion. Based on the measured changes in AT and PF lengths, θcal , θarch , and passive torque, AT and PF stiffness were determined. RESULTS Upon passive ankle dorsiflexion, AT and PF were lengthened; their length changes were inversely correlated. Men showed a stiffer AT, more compliant PF, less calcaneal rotation, and greater foot arch deformation compared with women. Furthermore, we found inverse correlations between AT stiffness and ROM of θcal , and between PF stiffness and ROM of θarch in men and women. CONCLUSIONS Passive AT and PF extensibility counter each other. AT and PF stiffness and passive ROM of ankle-foot components were countered between sexes; however, associations between stiffness and passive ROM of the ankle-foot complex were consistent between sexes. Our findings support the notion that the balanced mechanical interaction between the AT and PF can account for the passive ROM of the human ankle-foot complex in vivo , and the differences between sexes.
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Affiliation(s)
- HIROTO SHIOTANI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
| | - KATSUKI TAKAHASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Research Fellow of Japan Society for the Promotion of Science, Tokyo, JAPAN
| | - YUKI HONMA
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - KAZUKI TOMARI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - HIDETAKA HAYASHI
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, JAPAN
| | - NATSUKI SADO
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, JAPAN
| | - YASUO KAWAKAMI
- Faculty of Sport Sciences, Waseda University, Tokorozawa, JAPAN,Human Performance Laboratory, Comprehensive Research Organization of Waseda University, Tokyo, JAPAN
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Zhang L, Cai M, Gan Y, Xia Z, Xiong J, Sun X, Yang P, Tang H, Wang G. Anatomical features of plantar fasciitis in various age cohorts: Based on magnetic resonance imaging. J Orthop Surg (Hong Kong) 2023; 31:10225536231161181. [PMID: 36927205 DOI: 10.1177/10225536231161181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Due to the lack of further studies on the influence of age factors on plantar fasciitis, this study evaluates the characteristic observation points of magnetic resonance imaging in various age cohorts of patients with plantar fasciitis to help diagnosis. METHODS A retrospective analysis of 160 cases of plantar fasciitis patients and normal subjects (who have the disease unrelated to plantar fasciitis) who have undergone an MRI examination in our institution. The two groups were separately divided into young adult subjects (36 to 44 years old), middle age adult subjects (45 to 59 years old), and older adult subjects (60 to 79 years old). Data was gathered regarding plantar fascia thickness, the coronal length of the plantar fascia at the calcaneal origin, the signal intensity of plantar fascia and surrounding structures, and the presence or absence of plantar calcaneal spurs, all of which were assessed objectively by the investigators. RESULTS There were statistical differences in the thickness of plantar fascia between two groups of three age cohorts (Older adult patients: 0.59 ± 0.09 cm; Middle age adult patients: 0.49 ± 0.09 cm; Young adult patients: 0.47 ± 0.05 cm) (all p < 0.001). In addition, there were also statistical differences in the high signal intensity changes of the plantar fascia and surrounding soft tissues between two groups of three age cohorts (all p < 0.001). In older adult plantar fasciitis patients, with regard to plantar calcaneal spur discovery, there was a statistical difference between the two groups (Chi-square = 12.799. df = 1. p < 0.001). CONCLUSION In plantar fasciitis cases where a diagnosis is difficult, abnormalities in the soft tissue surrounding the plantar fascia in patients of low age are noteworthy. In older adult patients, the discovery of plantar calcaneal spurs with abnormal thickening of plantar fascia deserves attention, and abnormal MRI findings are more manifest. But the final diagnosis should be based on the medical history. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Mingyang Cai
- School of Traditional Chinese and Western Medicine, 74647Southwest Medical University, Luzhou, China
| | - Yiwen Gan
- School of Traditional Chinese and Western Medicine, 74647Southwest Medical University, Luzhou, China
| | - Zhangrong Xia
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Jixiang Xiong
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Xinghao Sun
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Peixin Yang
- School of Pediatrics, 74647Southwest Medical University, Luzhou, China
| | - Huining Tang
- School of Clinical Medicine, 74647Southwest Medical University, Luzhou, China
| | - Guoyou Wang
- Department of Orthopedics, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China.,Center for Orthopedic Diseases Research, 74647The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
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Chow TH, Chen YS, Hsu CC. Relationships between Plantar Pressure Distribution and Rearfoot Alignment in the Taiwanese College Athletes with Plantar Fasciopathy during Static Standing and Walking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412942. [PMID: 34948551 PMCID: PMC8702139 DOI: 10.3390/ijerph182412942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Plantar fasciopathy (PF) is usually related to changes in foot arch, foot shape and rearfoot posture. However, little research has been implemented by using large-scale datasets, and even less has been conducted centering on plantar pressure distributions (PPDs) of different genders of PF athletes. This study aimed to investigate the relationships among the arch index (AI), the PPDs and the rearfoot postural alignment in hundreds of college athletes with PF during static standing and walking. METHODS Cross-sectional study of 100 male and 102 female athletes with PF was undertaken. The PF athletes' pain assessment and self-reported health status were examined for evaluating their musculoskeletal painful areas. RESULTS The PF athletes' PPDs mainly concentrated on inner feet in static standing, and transferred to lateral forefeet during the midstance phase of walking. The males' PPDs from the static standing to the midstance phase of walking mainly transferred to anterolateral feet. The females' PPDs mainly transferred to posterolateral feet. The PF athletes' static rearfoot alignment matched the valgus posture pattern. The medial band of plantar fascia and calcaneus were the common musculoskeletal pain areas. CONCLUSIONS Characteristics of higher plantar loads beneath medial feet associated with rearfoot valgus in bipedal static stance could be the traceable features for PF-related foot diagrams. Higher plantar loads mainly exerted on the lateral forefoot during the midstance phase of walking, and specifically concentrated on outer feet during the transition from static to dynamic state. Pain profiles seem to echo PPDs, which could function as the traceable beginning for the possible link among pronated low-arched feet, PF, metatarsalgia, calcanitis and Achilles tendinitis.
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Affiliation(s)
- Tong-Hsien Chow
- Department of Leisure Sport and Health Management, St. John’s University, New Taipei 25135, Taiwan; (T.-H.C.); (C.-C.H.)
| | - Yih-Shyuan Chen
- Department of Education, National Pingtung University, Pingtung 900391, Taiwan
- Correspondence: ; Tel.: +886-8-7663800 (ext. 31464)
| | - Chin-Chia Hsu
- Department of Leisure Sport and Health Management, St. John’s University, New Taipei 25135, Taiwan; (T.-H.C.); (C.-C.H.)
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Weinrich L, Paraskevaidis M, Schleip R, Agres AN, Tsitsilonis S. Does the Calcaneus Serve as Hypomochlion within the Lower Limb by a Myofascial Connection?-A Systematic Review. Life (Basel) 2021; 11:life11080745. [PMID: 34440492 PMCID: PMC8398293 DOI: 10.3390/life11080745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Clinical approaches have depicted interconnectivity between the Achilles tendon and the plantar fascia. This concept has been applied in rehabilitation, prevention, and in conservative management plans, yet potential anatomical and histological connection is not fully understood. (2) Objective: To explore the possible explanation that the calcaneus acts as a hypomochlion. (3) Methods: 2 databases (Pubmed and Livivo) were searched and studies, including those that examined the relationship of the calcaneus to the Achilles tendon and plantar fascia and its biomechanical role. The included studies highlighted either the anatomical, histological, or biomechanical aspect of the lower limb. (4) Results: Seventeen studies were included. Some studies depicted an anatomical connection that slowly declines with age. Others mention a histological similarity and continuity via the paratenon, while a few papers have brought forward mechanical reasoning. (5) Conclusion: The concept of the calcaneus acting as a fulcrum in the lower limb can partially be supported by anatomical, histological, and biomechanical concepts. Despite the plethora of research, a comprehensive understanding is yet to be investigated. Further research exploring the precise interaction is necessary.
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Affiliation(s)
- Luise Weinrich
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Melissa Paraskevaidis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
| | - Robert Schleip
- Technische Universität München, 80333 München, Germany;
- Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Alison N. Agres
- Julius Wolff Institute, Berlin Institute of Health and Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Serafeim Tsitsilonis
- Center for Musculoskeletal Surgery, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (L.W.); (M.P.)
- Correspondence:
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Why heel spurs are traction spurs after all. Sci Rep 2021; 11:13291. [PMID: 34168232 PMCID: PMC8225903 DOI: 10.1038/s41598-021-92664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/11/2021] [Indexed: 11/24/2022] Open
Abstract
It is unclear whether plantar and posterior heel spurs are truly pathological findings and whether they are stimulated by traction or compression forces. Previous histological investigations focused on either one of the two spur locations, thereby potentially overlooking common features that refer to a uniform developmental mechanism. In this study, 19 feet from 16 cadavers were X-ray scanned to preselect calcanei with either plantar or posterior spurs. Subsequently, seven plantar and posterior spurs were histologically assessed. Five spur-free Achilles tendon and three plantar fascia entheses served as controls. Plantar spurs were located either intra- or supra-fascial whereas all Achilles spurs were intra-fascial. Both spur types consistently presented a trabecular architecture without a particular pattern, fibrocartilage at the tendinous entheses and the orientation of the spur tips was in line with the course of the attached soft tissues. Spurs of both entities revealed tapered areas close to their bases with bulky tips. Achilles and plantar heel spurs seem to be non-pathological calcaneal exostoses, which are likely results of traction forces. Both spur types revealed commonalities such as their trabecular architecture or the tip direction in relation to the attached soft tissues. Morphologically, heel spurs seem poorly adapted to compressive loads.
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