Department of Orthopaedic Surgery, University of Amsterdam, Amsterdam, the Netherlands.
J Anat. 2011 Mar;218(3):336-41. doi: 10.1111/j.1469-7580.2011.01335.x.
The source of pain and the background to the pain mechanisms associated with mid-portion Achilles tendinopathy have not yet been clarified. Intratendinous degenerative changes are most often addressed when present. However, it is questionable if degeneration of the tendon itself is the main cause of pain. Pain is often most prominent on the medial side, 2-7cm from the insertion onto the calcaneus. The medial location of the pain has been explained to be caused by enhanced stress on the calcaneal tendon due to hyperpronation. However, on this medial side the plantaris tendon is also located. It has been postulated that the plantaris tendon might play a role in these medially located symptoms. To our knowledge, the exact anatomy and relationship between the plantaris- and calcaneal tendon at the level of complaints have not been anatomically assessed. This was the purpose of our study. One-hundred and seven lower extremities were dissected. After opening the superficial fascia and paratendon, the plantaris tendon was bluntly released from the calcaneal tendon moving distally. The incidence of the plantaris tendon, its course, site of insertion and possible connections were documented. When with manual force the plantaris tendon could not be released, it was defined as a 'connection' with the calcaneal tendon. In all specimens a plantaris tendon was identified. Nine different sites of insertion were found, mostly medial and fan-shaped onto the calcaneus. In 11 specimens (10%) firm connections were found at the level of the calcaneal tendon mid-portion. Clinical and histological studies are needed to confirm the role of the plantaris tendon in mid-portion Achilles tendinopathy.
跟腱中段腱病相关的疼痛源和疼痛机制背景尚未阐明。通常主要针对存在的腱内退行性改变进行治疗。然而，跟腱本身的退行性变是否是疼痛的主要原因仍存在疑问。疼痛通常在距跟骨附着处 2-7cm 处的内侧最为明显。疼痛的内侧位置被解释为由于过度旋前导致跟腱承受的压力增加所致。然而，在这个内侧位置也有足底肌腱。有人推测足底肌腱可能在这些内侧位置的症状中起作用。据我们所知，跟骨和足底肌腱在有症状的水平的精确解剖结构和关系尚未进行解剖评估。这就是我们研究的目的。我们解剖了 107 条下肢。在切开浅筋膜和腱旁组织后，从跟腱远端向近端钝性分离足底肌腱。记录了足底肌腱的出现率、走行、附着部位和可能的连接。当用手的力量无法释放足底肌腱时，将其定义为与跟腱的“连接”。在所有标本中均发现了足底肌腱。发现了 9 种不同的附着部位，主要位于跟骨的内侧和扇形。在 11 个标本（10%）中，在跟腱中段发现了牢固的连接。需要进行临床和组织学研究以确认足底肌腱在跟腱中段腱病中的作用。
