The Forgotten Tendon

Hello, let me introduce myself. My name is plantaris tendon and I don’t know why nobody consider me; maybe because I’m not present in about 10-12% of the population? I’m the longest tendon in the human body. My muscle belly arise from the inferior part of the lateral supracondylar ridge of the femur, at a position slightly superior to the origin of the lateral head of gastrocnemius. I pass posterior to the knee joint in an inferomedial direction where I was born as a tendon, side by side with medial gastrocnemius and soleus; my insertion is into the Achilles tendon but sometimes you can find me also in medial side of the calcaneus. I act to weakly plantar flex the ankle joint and flex the knee joint. The only one that remember me is the orthopaedic surgeon, because in some situations he uses my body to repair the Achilles tendon. Everytime a sonographer finds a fluid collection along my medial course, says that medial head of gastrocnemius is injured. Ok, my isolated tears are less frequent than medial gastrocnemius strains and clinically similar, but the prognosis is different. Please, don’t forget about me. Please.

prove

Axial T2w spair mri scan of a 2nd degree strain of the plantaris tendon  of a professional football player. Medial head of gastrocnemius is normal.

Sagittal ultrasound exam of the same patient.

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Ultrasound sagittal scan with Power-Doppler evaluation.

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2 thoughts on “The Forgotten Tendon

  1. I think they are more frequent than the literature suggests. In fact, i’d say about 15-20% of clinically diagnosed tennislegs is an isolated plantaris tendon tears based on the 20-25 scans i made of this area. Interesting the thing you mention on prognosis. How does a plantaris tear compare in prognosis compared to gastroc/soleus tears?

    • Thank you for your question. I agree with you: isolated plantaris tendon tears are more frequent than reported in literature. In my experience there is a great difference about prognosis; the main problem is that, as you certainly know, the posterior tibial nerve passes in the same area of plantaris tendon/medial gastrocnemius, giving bad feeling to patients even if there are no particular risks for the return to sport activity. Once I’m sure that is an isolated plantaris tendon tear, I use to accelerate the return to regular training. The patient that I mentioned in the blog, returned to regular activity after twenty days without any kind of recurrence. In these cases I always use dynamic ultrasound and elastosonography for monitoring the injury.

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