Abstract
Purpose
The plantaris tendon is present in 98–100 % of people, and a potential relationship between the plantaris tendon and the development of Achilles tendinopathy has been postulated. There are no studies on the epidemiology of plantaris injuries in a sporting population. This retrospective cohort study presents the incidence, nature and outcome of plantaris injuries in elite British track and field athletes.
Method
All 214 elite athletes supported by the British Athletics Medical team from 2009 to 2013 were included in this cohort study. An injury was recorded if a plantaris injury was diagnosed and confirmed with imaging or surgical findings. Patient demographics, injury details and return to competitive elite track and field were recorded.
Results
There were 33 new plantaris injuries, with an annual plantaris injury incidence of 3.9–9.3 %. There were significantly more right-sided plantaris injuries in bend running sprinters (15 right-sided vs. 4 left-sided). 74 % of the athletes who had a plantaris injury also had Achilles tendinopathy at some point during the study period. Seventeen plantaris tendons were surgically removed from 13 athletes during the course of the study with 12 of the 13 athletes returning to the same level on the Tegner activity scale.
Conclusion
This retrospective cohort study demonstrates that plantaris injuries are common in elite track and field athletes and may be underreported in the literature. There may be an association between the biomechanics bend sprinting and plantaris injury. Elite athletes may benefit from appropriate preventative and management strategies implemented by coaching and medical teams.
Level of evidence
IV.
Similar content being viewed by others
References
Alfredson H (2011) Midportion Achilles tendinosis and the plantaris tendon. Br J Sports Med 45:1023–1025
Alfredson H (2011) Ultrasound and Doppler-guided mini-surgery to treat midportion Achilles tendinosis: results of a large material and a randomised study comparing two scraping techniques. Br J Sports Med 45:407–410
Andersson G, Danielson P, Alfredson H, Forsgren S (2007) Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 15:1272–1279
Bianchi S, Sailly M, Molini L (2011) Isolated tear of the plantaris tendon: ultrasound and MRI appearance. Skeletal Radiol 40:891–895
Chang Y-H, Kram R (2007) Limitations to maximum running speed on flat curves. J Exp Biol 210:971–982
Cook J, Purdam C (2011) Is compressive load a factor in the development of tendinopathy? Br J Sports Med 46:163–168
Delgado GJ, Chung CB, Lektrakul N, Azocar P, Botte MJ, Coria D, Bosch E, Resnick D (2002) Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology 224:112–119
Dijkstra HP, Pollock N, Chakraverty R, Alonso JM (2014) Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med 48:523–531
Freeman AJ, Jacobson NA, Fogg QA (2008) Anatomical variations of the plantaris muscle and a potential role in patellofemoral pain syndrome. Clin Anat 21:178–181
Gopinath TN, Jagdish J, Krishnakiran K, Shaji PC (2012) Rupture of plantaris muscle—a mimic: MRI findings. J Clin Imaging Sci 2:19
Hamilton W, Klostermeier T, Lim EV, Moulton JS (1997) Surgically documented rupture of the plantaris muscle: a case report and literature review. Foot Ankle Int 18:522–523
Harmon KJ, Reeder MT, Udermann BE, Murray SR (2006) Isolated rupture of the plantaris tendon in a high school track athlete. Clin J Sport Med 16:361–363
Harvey FJ, Chu G, Harvey PM (1983) Surgical availability of the plantaris tendon. J Hand Surg 8:243–247
Helms CA, Fritz RC, Garvin GJ (1995) Plantaris muscle injury: evaluation with MR imaging. Radiology 195:201–203
Humphrey J, Chan O, Crisp T, Padhiar N, Morrissey D, Twycross-Lewis R, King J, Maffulli N (2010) The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy. J Sci Med Sport 13:295–298
Lintz F, Higgs A, Millett M, Barton T, Raghuvanshi M, Adams MA, Winson IG (2011) The role of plantaris longus in Achilles tendinopathy: a biomechanical study. Foot Ankle Surg 17:252–255
Miller WA (1977) Rupture of the musculotendinous juncture of the medial head of the gastrocnemius muscle. Am J Sports Med 5:191–193
Nayak SR, Krishnamurthy A, Ramanathan L, Ranade AV, Prabhu LV, Jiji PJ, Rai R, Chettiar GK, Potu BK (2010) Anatomy of plantaris muscle: a study in adult Indians. Clin Ter 161:249–252
Pearce CJ, Carmichael J, Calder JD (2012) Achilles tendinoscopy and plantaris tendon release and division in the treatment of non-insertional Achilles tendinopathy. Foot Ankle Surg 18:124–127
Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, Jaberzadeh S, Cook J (2014) The pain of tendinopathy: physiological or pathophysiological? Sports Med 44:9–23
Saxena A, Bareither D (2000) Magnetic resonance and cadaveric findings of the incidence of plantaris tendon. Foot Ankle Int 21:570–572
Schubert TEO, Weidler C, Lerch K, Hofstädter F, Straub RH (2005) Achilles tendinosis is associated with sprouting of substance P positive nerve fibres. Ann Rheum Dis 64:1083–1086
Severance HW Jr, Bassett FH 3rd (1982) Rupture of the plantaris—does it exist? J Bone Joint Surg Am 64:1387–1388
Simpson SL, Hertzog MS, Barja RH (1991) The plantaris tendon graft: an ultrasound study. J Hand Surg 16:708–711
Steenstra F, van Dijk CN (2006) Achilles tendoscopy. Foot Ankle Clin 11:429–438
Van Sterkenburg MN, Kerkhoffs GMMJ, van Dijk CN (2011) Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 19:1362–1366
Van Sterkenburg MN, Kerkhoffs GMMJ, Kleipool RP, Niek van Dijk C (2011) The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study. J Anat 218:336–341
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD (2002) A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 36:95–101
Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pollock, N., Dijkstra, P., Calder, J. et al. Plantaris injuries in elite UK track and field athletes over a 4-year period: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc 24, 2287–2292 (2016). https://doi.org/10.1007/s00167-014-3409-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-014-3409-3