Open Access Journal of Sports Medicine (Apr 2024)
Tendinopathic Plantaris but Normal Achilles Tendon Found in About One-Fifth of Patients Not Responding to Conservative Achilles Tendon Management – Results from a Prospective WALANT Surgical Case Series on 105 Tendons
Abstract
Håkan Alfredson,1,2 Markus Waldén,3,4 David Roberts,3 Christoph Spang5– 7 1Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umeå, Sweden; 2Alfredson Tendon Clinic, Capio Ortho Center Skåne, Malmö, Sweden; 3Capio Ortho Center Skåne, Malmö, Sweden; 4Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 5Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden; 6Private Orthopaedic Spine Center, Würzburg, Germany; 7Institute for Sports Science, Würzburg University, Würzburg, GermanyCorrespondence: Håkan Alfredson, Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umeå, 90187, Sweden, Tel +46 (0) 702288441, Email [email protected]: Midportion Achilles tendinopathy is a relatively common condition. This study aimed to investigate the presence of a normal Achilles tendon, but a tendinopathic plantaris tendon, in a large and consecutive prospective sample of patients referred to a specialised tendon clinic for midportion Achilles tendon pain not responding to non-surgical treatment.Patients and Methods: A total of 105 consecutive tendons were operated on in 81 patients (62 males) suffering from painful midportion Achilles tendon pain. Clinical examination, ultrasound (US) and colour Doppler (CD) examination, and wide awake local anaesthetic no tourniquet (WALANT) surgery were performed in all patients.Results: For 19/105 (18%) tendons from 14 patients, clinical examination suspected plantaris tendinopathy alone as there was a distinct tenderness on the medial side, but no thickening of the Achilles tendon. US examination followed by surgery confirmed the diagnosis.Conclusion: Midportion Achilles tendon pain is not always related to Achilles tendinopathy since pain related to the plantaris tendon alone was found in almost every fifth patient. Consequently, there is an obvious need for proper examination to identify the pain source and establish a correct diagnosis before treatment.Keywords: Achilles tendinopathy, surgery, plantaris, consecutive, ultrasound
