Morphological variations of the calcaneal tendon: clinical significance.

The calcaneal tendon, the largest and strongest in the human body, is created by the common junction of tendons of the gastrocnemius and soleus muscles. It is not a homogenous structure, being represented by layers in various arrangements. Morphological variability can be seen in the connection between the aponeurosis of the gastrocnemius muscle and the soleus muscle. Some types of plantaris tendon can be associated with a higher possibility of Achilles tendinopathy. Moreover, the presence of accessory structures, such as an accessory soleus muscle or additional gastrocnemius muscle heads may result in symptomatic pathologies. The main aim of this review is to summarize the current state of knowledge regarding the calcaneal tendon. Another aim is to present morphological variations of the calcaneal tendon and their clinical significance. Such information may be useful for clinicians, especially orthopedists, and surgeons. This review also provides an overview of embryological development and morphological variation among fetuses. Materials and methods: review was conducted according to PRISMA guidelines. An electronic search was conducted in five databases. Top quality tools were used to assess the quality of evidence in the studies reviewed. Research papers that made up the database of this review were analyzed, selected and assessed by two independently working researchers.