PubMed Health⌕ Search

PubMed · 15922921

Insertional Achilles tendinopathy.

Abstract

There has been significant progress in our understanding of Achilles insertional tendinopathy since Clain and Baxter divided Achilles tendon disorders into noninsertional and insertional tendinopathy in 1992. In this article we specifically concentrate on Achilles insertional tendinopathy. Classically, overuse and poor training habits are considered to be the main etiology of Achilles insertional tendinopathy. This article discusses Achilles insertional tendinopathy from the anatomy of to its management.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Murali Krishna Sayana, Nicola Maffulli. 2005. Insertional Achilles tendinopathy.. https://doi.org/10.1016/j.fcl.2005.01.010

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Anatomic variations of the musculotendinous junction of the soleus muscle and its clinical implications.

The soleus muscle, like the gastrocnemius, is a powerful plantarflexor muscle in the lower limb. The soleus muscle joins the aponeurosis of the gastrocnemius muscle to form the calcaneal (Achilles) tendon. While the basic anatomy of the soleus muscle has been previously described, no study has addressed the anatomical variations of its distal attachment. We found considerable anatomic variation in the distance between this musculotendinous junction and the most proximal point of the proximal edge. This distal measuring point was defined as the most proximal point of the proximal edge of the posterior surface of the calcaneal tuberosity. Eighty human cadaver specimens were preserved according to Thiel's method; we examined one limb from each cadaver, studying 80 lower extremities in total. Following careful dissection of the lower limb, we measured the distance between the distal point of attachment of the soleus muscle fibers (the musculotendinous junction) and the designated measuring point. Our findings were divided into three groups: Group 1 (10 cases, 12.5%), where the distance between the musculotendinous junction and the designated point on the calcaneal tuberosity was between 0 and 1 inches; Group 2 (56 cases, 70%), where the distance was between 1 and 3 inches; and Group 3 (14 cases, 17.5%), where the distance was greater than 3 inches. Detailed knowledge of the anatomic variations of the soleus muscle at its insertion point onto the calcaneal tendon has clinical implications in calcaneal tendon repair following rupture and in the planning of reconstructive surgery using soleus muscle flaps.

Achilles Tendon↗

Physical activity modulates nerve plasticity and stimulates repair after Achilles tendon rupture.

In a rat model of tendon rupture using semiquantitative methodology, healing was assessed according to the diameter of newly organized collagen and the occurrence of the sensory neuropeptides (SP, CGRP) in relation to different levels of physical activity. Normally, innervation of the Achilles tendon is confined to the paratenon. After rupture new nerve fibers grow into the tendon proper, but disappear after healing. In a first experiment to establish peak tissue and nerve regeneration after rupture, tendon tissues from freely moving rats were collected consecutively over 16 weeks. A peak increase in organized collagen and nerve ingrowth was observed between week 2 to 4 post rupture. Therefore, in a second experiment week 4 was chosen to assess the effect of physical activity on tendon healing in three groups of rats, that is, wheel running, plaster treated, and freely moving (controls). In the wheel-running group, the diameter of newly organized collagen was 94% ( p = 0.001) greater than that in the plaster-treated group and 48% ( p = 0.02) greater than that in the controls. Inversely, the neuronal occurrence of CGRP in the tendon proper was 57% ( p = 0.02) lower in the wheel-running group than that in the plaster-treated group and 53% ( p = 0.02) lower than that in the controls, suggesting an earlier neuronal in-growth and disappearance in the more active group. Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity.

Achilles Tendon↗