For managing plantaris pain presenting like a tendinopathy, management will be similar to an Achilles insertional tendinopathy. Initially isometrics can be helpful in reducing tendon pain.
If the patient has pain into dorsiflexion, initially management will involve avoiding loading down into dorsiflexion eccentrics. Similarly, if this occurs during running dorsiflexion may also be reduced, by changing stride length, cadence and or foot placement see HERE for related blog posts to running technique. Gradual progression to faster, higher loads through the tendon will occur guided by your physiotherapist. Treating plantaris tendinopathy may also incorporate changes in footwear and incorporate heel raises to help de-load compression of the tendon.
Additionally manual therapy and taping may be useful for Plantaris to settle down the tendon. Click HERE for a framework on how to best select running shoes. The plantaris is an important factor to be considered and treated to successfully manage Achilles tendon pain. If you are unsure about best diagnosis and best management please contact your local Physiotherapist to get you back on track to better and pain-free performance. The plantaris muscle: anatomy, injury, imaging, and treatment.
The Journal of the Canadian Chiropractic Association, 51 3 , Achilles tendinopathy—do plantaris tendon removal and Achilles tendon scraping improve tendon structure? A prospective study using ultrasound tissue characterisation.
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We understand the importance of convenience to fit around your busy lifestyle. Our Physiotherapy practice in Mermaid Waters works with clients all over the Gold Coast including the following suburbs:. Achilles Tendinopathy or is it your Plantaris? By Brad Beer. In Tendon Conditions. Related: The 3 key stages of achilles tendinopathy exercises Related: The best exercise for insertional achilles tendon pain The plantaris tendon as a possible source of pain An important and often overlooked factor in Achilles tendon pain, is the plantaris tendon.
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All the staff, from Michael the physio, Sato the massage therapist and Matt at reception were wonderful. Well trained, friendly and professional. I cannot thank you all enough. Together they have got me moving pain free. Their program works! Alana Pollard 22 May Pogo physio has not only helped me get out of pain but has helped me become a better, happier runner. As soon as you walk through the door you feel welcome and after my first session with Brad I had no doubts he would get me back to my best.
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Chris Mallac explains why, and how to manage an injury to either. The plantaris muscle PM is a small, thin, and spindle-shaped muscle 1. Along with the soleus and gastrocnemius, it is part of the muscle group known collectively as the triceps surae. The PM originates on the lateral supracondylar line of the femur, just above and slightly medial to the origin of the lateral head of the gastrocnemius, and lateral to the popliteal vessels and tibial nerve see figure 1 1.
Cadaver studies reveal the origin of the PM can have many variations, including blending with the oblique popliteal ligament 1,5,6. From its origin, the PM courses downwards in an inferior and medial direction across the popliteal fossa.
It has a long thin tendon mean length varying from The tendon continues along the medial aspect of the Achilles tendon AT and inserts in up to nine different anatomical variations These anomalies include insertion into the AT itself, the fascia of the lower leg, the plantar aponeurosis, or the flexor retinaculum of the ankle.
The most common insertion, however, is a wide fan-shaped placement medial to the PT on the calcaneal tuberosity 11, The AT does not have a synovial sheath as other tendons in the body; instead, it has a paratendon, which is a thin, fibrous, and highly vascularized band of tissue. The PT runs within this paratendinous sheath, and this may be a potential site of adhesions between the PT and AT 1, The PM is a weak plantar flexor of the ankle and flexor of the knee, and its main role may be proprioceptive — as evidenced by the large numbers of muscle spindles contained within the small body of the muscle 1,2,8, The mechanism of injury to the PM may be similar to that of the gastrocnemius — a sudden eccentric load while moving into ankle dorsiflexion with the knee extended — as occurs in jumping and sprinting 16, However, they may not lose power when running and jumping.
A tear in the medial gastrocnemius sometimes referred to as tennis leg can occur as well The next day, the calf may present with extreme soreness, and bruising may track down the inside of the calf muscle.
Dorsiflexion both passive and active and resisted plantar flexion produce pain. A plantaris injury may occur as an isolated injury, in combination with a soleus and gastrocnemius tear, or an ACL injury 5,6.
Damage is more common in the proximal muscle belly or the musculotendinous junction but infrequently occurs through the tendon 18, Ruptures isolated to the distal tendon are tender to palpation two to three centimeters above the calcaneal insertion on the medial side of the AT and are typically mildly swollen In recent years, there has been some interest in the relationship between mid-portion Achilles tendinopathy and the presence of an enlarged PT, which may compress the AT. The reasoning is as follows:.
The symptoms of plantaris-related Achilles pain differ from classic Achilles tendinopathy. Athletes with the plantaris-related variety usually participate in sports that require explosive full-range ankle joint movements and complain of sharp pain on the medial side of the AT during push-off. Furthermore, moving from loaded plantar flexion to dorsiflexion, such as when lowering from a calf raise, may elicit pain In some symptomatic cases, when the AT was investigated in surgery, the PT was found fused to the AT at the same location as the reported pain This anatomical variation creates an area of compression between the PT and the AT, rather than a natural gliding action between the two.
The results of many studies largely support this view:. MRI and ultrasonography are both suitable for investigating muscle or tendon tear, or the involvement of the PT in AT pathology. An MRI evaluation may show 19 :. Ultrasound reveals a hyper-echoic structure with an internal fibrillar appearance In this instance, signs of a classic tendinopathy in the AT appear very close to the area where the PT pushes against the AT.
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