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Development and growth of the calcaneal tendon sheath with special reference to its topographical relationship with the tendon of the plantaris muscle: a histological study of human fetuses

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Abstract

Background and purpose

The calcaneal tendon sheath has several vascular routes and is a common site of inflammation. In adults, it is associated with the plantaris muscle tendon, but there are individual variations in the architecture and insertion site. We describe changes of the tendon sheath during fetal development.

Materials and methods

Histological sections of the unilateral ankles of 20 fetuses were examined, ten at 8–12 weeks gestational age (GA) and twelve at 26–39 weeks GA.

Results

At 8–12 weeks GA, the tendon sheath simply consisted of a multilaminar layer that involved the plantaris tendon. At 26–39 weeks, each calcaneal tendon had a multilaminar sheath that could be roughly divided into three layers. The innermost layer was attached to the tendon and sometimes contained the plantaris tendon; the multilaminar intermediate layer contained vessels and often contained the plantaris tendon; and the outermost layer was thick and joined other fascial structures, such as a tibial nerve sheath and subcutaneous plantar fascia. The intermediate layer merged with the outermost layer near the insertion to the calcaneus.

Conclusion

In spite of significant variations among adults, the fetal plantar tendon was always contained in an innermost or intermediate layer of the calcaneal tendon sheath in near-term fetuses. After birth, mechanical stresses such as walking might lead to fusion or separation of the multilaminar sheath in various manners. When reconstruction occurs postnatally, there may be individual variations in blood supply routes and morphology of the distal end of the plantaris tendon.

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Data availability

All data used in this work are available for verification upon request.

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Funding

This study was supported in part by a Grant-in-Aid for Scientific Research (JSPS KAKENHI No. 16K08435; to Hiroshi Abe) from the Ministry of Education, Culture, Sports, Science and Technology in Japan.

Author information

Authors and Affiliations

  1. Department of Anatomy, Division of Basic Medicine, Tokai University School of Medicine, Isehara, Japan

    Shogo Hayashi

  2. Department of Anatomy, Jeonbuk National University Medical School, Geunji-ro 20, Deokjin-gu, Jeonju, 54907, Republic of Korea

    Ji Hyun Kim

  3. Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China

    Zhe Wu Jin

  4. Division of Internal Medicine, Cupid Clinic, Iwamizawa, Japan

    Gen Murakami

  5. Department of Anatomy and Embryology, School of Medicine, Complutense University, Madrid, Spain

    José Francisco Rodríguez-Vázquez

  6. Emeritus Professor of Akita University School of Medicine, Akita, Japan

    Hiroshi Abe

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  1. Shogo Hayashi
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  2. Ji Hyun Kim
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  3. Zhe Wu Jin
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  4. Gen Murakami
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  5. José Francisco Rodríguez-Vázquez
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Contributions

SH: project development, data collection, data analysis, manuscript writing. JHK: project development, data collection, manuscript writing, manuscript editing. ZWJ: data management, data analysis, manuscript editing. GM: project development, data collection, data analysis, manuscript writing, manuscript editing. JFRV: data collection, data analysis, manuscript editing. HA: data analysis, manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ji Hyun Kim.

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The authors declare no competing interests.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki. The use of these specimens was approved by the Ethics Committee of Complutense University (B08/374) and Akita University (No. 1428).

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Hayashi, S., Kim, J.H., Jin, Z.W. et al. Development and growth of the calcaneal tendon sheath with special reference to its topographical relationship with the tendon of the plantaris muscle: a histological study of human fetuses. Surg Radiol Anat 45, 247–253 (2023). https://doi.org/10.1007/s00276-023-03086-y

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