SLR- December 2013- Landon Cameron and Matt Ramirez
Reference: Plantar Fasciaanatomy and Its Relationship with Achilles Tendon and Paratenon
Carla Stecco, Marco Corradin, Veronica Macchi, Aldo Morra, Andrea Porzionato, CarloBiz, Raffaele De Caro. Journal of Anatomy (2013). doi:10.1111/joa.12111
Scientific Literature Review
Reviewed By: Landon T. Cameron, DPM, Matt Ramirez, DPM
Residency Program: Hunt Regional Medical Center
Podiatric Relevance: The objective of this investigation was to have a better understanding of the anatomy of the plantar fascia including the macro- and micro-relationship it shares with the triceps surae muscle complex. It also investigated how it is affected by certain pathologies related to the triceps surae muscle complex.
Methods: In the first stage of this investigation, twelve feet from human cadavers were dissected to isolate the plantar fascia (PF). Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of specific foot or ankle pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted.
Results: The first stage of the study revealed that the plantar fascia is more closely connected to the paratenon of the Achilles tendon than to the tendon itself via the periosteum of the calcaneus. The plantar fascia extends medially and laterally and is continuous with the fascia that envelopes the abductor digiti minimi and the abductor hallucis. Nerve endings are present in the plantar fascia including Pacini and Ruffini corpuscles suggesting that the PF may play a role in proprioception of the foot. Hyaluronun was also found in high concentrations in the PF. The second stage of the study revealed that in patients with Achilles tendonopathy, the PF was increased in thickness and the increase was statistically significant (p<.0001) when compared to the control group. The increased thickness was also above the threshold for diagnosing plantar fasciitis. The authors concluded that the pathology of the triceps surae complex and the plantar fascia are linked very closely.Conclusions: At this point nothing has been published about the possible role the PF plays inproprioception, however, due to the presence of Pacini and Ruffini corpuscles, this may be the case. The authors suggest that due to the presence of hyaluronan inside the plantar fascia, ahyaluronan injection may be a more appropriate injection versus corticosteroid. This has been documented well in animal studies to reduce nociception. Although the connection between the triceps surea and the plantar fasciais only through the paratenon, the data suggest that there is a direct relationship between tight posterior leg muscles and plantar fasciitis,indicating that conservative treatment should address this as well.