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Plantaris Tendon Tear

Rupture of Plantaris Tendon

One of the possible causes of calf pain is a plantaris tendon tear. Plantaris is a small muscle that is thought to be vestigial. It has a long tendon that spans over two joints, making it susceptible to tears.


Presentation

The plantaris muscle runs in the posterior compartment of the leg, as part of the triceps surae muscle group, while its tendon attaches to the calcaneus bone of the foot either independently or after converging with the Achilles tendon. The plantaris tendon stretches over both the knee and ankle joints, which makes it particularly susceptible to rupture, commonly occurring when the knee is extended while the ankle joint is dorsiflexed [1]. It is a frequent injury in tennis players and has sometimes been referred to as tennis leg, although it is generally agreed that this term, more often than not, describes injury of the gastrocnemius muscle, with or without concurrent soleus muscle injury. Loss of limb function is not a typical finding in a plantaris tendon tear (PTT), furthermore, the muscle is capable of repairing itself without the aid of surgery [2]. PTT has features similar to other more serious conditions such as deep vein thrombosis (DVT), Achilles tendon rupture and malignancy, which may need further, sometimes invasive intervention [2].

Complications may lie in the presence of tissue swelling and hematoma formation that may lead to compartment syndrome, which is an indication for emergent fasciotomy.

Although extremely rare, PTT may occur in isolation, or more frequently in combination with other muscle injuries such as trauma to the Achilles tendon [3] [4]. It is mostly reported in young active individuals and older patients with a sedentary lifestyle.

Symptoms of PTT are calf pain and tenderness that gradually increase after physical activity is stopped, swelling, and a popping or tearing sound. These are acute in onset. Cases in the past have been diagnosed surgically.

Falling
  • A rupture or tear can occur with a trip or fall, or usually during actions requiring explosive acceleration, such as pushing off or jumping.[patientslikeme.com]
  • You may even fall to the ground, the pain is sudden, sharp and you can’t take another step. The friend next to you in the golf cart says, “You tore your Achilles,” but you can still walk.[southplattesentinel.com]
  • On a cold morning a few weeks ago while rushing forward to get a drop shop something hit me like an immediate leg cramp and i made a soft fall on the ground. I even heard a sound that wasn't a pop, but more like a paper tearing.[tt.tennis-warehouse.com]
  • You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon. You fall from a significant height or abruptly step into a hole or off of a curb.[emedicinehealth.com]
  • Common examples include: Increasing the intensity of sports participation, especially in sports that involve jumping Falling from a height Stepping into a hole Risk factors Factors that may increase your risk of Achilles tendon rupture include: Age.[mayoclinic.org]
Aspiration
  • Health Center, ASPIRE Doha Qatar 3. Struttura complessa di Radiodiagnostica Ospedale Galliera Genova Italy[link.springer.com]
  • […] ligamentous damage (chronic and acute) Bursitis Joint effusion Vascular pathology Haematomas Soft tissue masses such as ganglia, lipomas Classification of a mass eg solid, cystic, mixed Post surgical complications eg abscess, oedema Guidance of injection, aspiration[ultrasoundpaedia.com]
Calf Pain
  • One of the possible causes of calf pain is a plantaris tendon tear. Plantaris is a small muscle that is thought to be vestigial. It has a long tendon that spans over two joints, making it susceptible to tears.[symptoma.com]
  • Conclusion The causes of calf pain are multiple, and often difficult to diagnose clinically.[radsource.us]
  • The deep calf pain persists and may be accompanied by mild to moderate swelling and ecchymosis. Neurovascular function will be intact.[aneskey.com]
  • In this case 36 year old male felt calf pain. His physician sent him for an MRI, with a prescription stating, "MRI right distal leg, possible Achilles tear".[musculoskeletalmri.blogspot.com]
Calf Pain
  • One of the possible causes of calf pain is a plantaris tendon tear. Plantaris is a small muscle that is thought to be vestigial. It has a long tendon that spans over two joints, making it susceptible to tears.[symptoma.com]
  • Conclusion The causes of calf pain are multiple, and often difficult to diagnose clinically.[radsource.us]
  • The deep calf pain persists and may be accompanied by mild to moderate swelling and ecchymosis. Neurovascular function will be intact.[aneskey.com]
  • In this case 36 year old male felt calf pain. His physician sent him for an MRI, with a prescription stating, "MRI right distal leg, possible Achilles tear".[musculoskeletalmri.blogspot.com]
Heel Pain
  • Ready to find the right treatment for your heel pain? Shop our orthotic solutions. Do you have questions about symptoms of heel pain you’ve recently noticed? Phone our heel pain experts at 877-215-3200.[heelthatpain.com]
  • Heel pain may arise from the fat pad itself.[pubs.rsna.org]
  • pain, need for revisional surgery, and/or catastrophic loss.[bunionsurgeryny.com]
  • Heel pain. (It may be severe.) Not being able to go on tiptoe with the hurt leg.[northshore.org]
Leg Cramp
  • On a cold morning a few weeks ago while rushing forward to get a drop shop something hit me like an immediate leg cramp and i made a soft fall on the ground. I even heard a sound that wasn't a pop, but more like a paper tearing.[tt.tennis-warehouse.com]
  • Typical symptoms of a plantaris muscle rupture include: Sudden pain in the back of the calf A swelling or bunching of the calf muscle Swelling and bruising in the back of the leg Cramping and spasm sensations of the calf muscle Diagnosis The most important[verywell.com]
Tendon Disorder
  • Drug-induced tendon disorders. Adv Exp Med Biol 2016; 920 : 229–238. [ PubMed ] [ Google Scholar ] 3. Braun D, Petitpain N, Cosserat F, et al. Rupture of multiple tendons after levofloxacin therapy.[ncbi.nlm.nih.gov]
Unable to Walk
  • The patient is unable to bear weight, unable to walk and is obviously in severe distress. The patient with the plantaris tear can often hobble, walk and mobilize, but is simply in moderate distress.[southplattesentinel.com]
  • You may be unable to walk without help from crutches, even then it will be difficult to weight bear and many people choose to hop instead! Management of these injuries varies considerably and will be guided by your consultant or physiotherapist.[running-physio.com]
  • Where injuries are more severe, the exact mechanism of injury is easier to recall and/or the individual may be unable to walk due to severe pain. A calf muscle tear is graded from I to III, with grade III being the most severe.[physio-pedia.com]

Workup

To distinguish a plantaris tendon tear from other disorders, a number of imaging studies are employed [5]. They include the following:

  • Ultrasound: This is a useful tool in visualizing the vasculature and musculature of the leg while ruling out differentials [6] [7]. Hematomas and fluid collection can easily be seen. Longitudinal scanning of the calf reveals PTT, which may appear as a fluid compartment between the soleus and gastrocnemius muscles [8]. The latter may be the only sign of pathology and indicates plantaris tendon strain [9] [10].
  • Magnetic resonance imaging (MRI): This is one of the main imaging tools that are employed. In addition to confirming the diagnosis, it may also be utilized to assess the severity of the injury, including involvement of other muscles [4]. A normal MRI warrants further investigation, as the likelihood of a deep vein thrombosis, is increased.
  • Diagnosis through surgical means has been used in the past.
  • Color Doppler: This technique is efficacious in revealing findings of DVT.
  • MR venography.

Treatment

  • Although it may take some time for complete recovery, the mode of treatment is conservative in majority of cases.[tandurust.com]
  • Unlike these conditions, plantaris tear has a benign outcome and does not need surgical treatment or anticoagulation.[link.springer.com]
  • […] ultrasound content, and updates to pearls and pitfalls in every chapter Expert guidance on ischiofemoral impingement and femoral acetabular impingement (FAI), as well as new information on sports medicine injuries and hip and pelvic imaging techniques and treatment[books.google.com]

Prognosis

  • Ok, my isolated tears are less frequent than medial gastrocnemius strains and clinically similar, but the prognosis is different. Please, don’t forget about me. Please.[coachingultrasound.com]
  • […] gastrocnemius and superficial to the soleus a focal area of disruption of muscle continuity noted along the deep aspect of the medial head of the gastrocnemius, with associated muscle edema the plantaris tendon may either be torn or intact Treatment and prognosis[radiopaedia.org]
  • Plantaris tendon tears are treated conservatively, and have an excellent prognosis, unlike Achilles tears, which have a much more prolonged recovery, and may need to be addressed surgically. Vic David MD Orthoradiology.com[musculoskeletalmri.blogspot.com]
  • Prognosis was the worst when a hematoma formed near the MTJ. One case in our series [Figure 12] presented with pain near the posterior aspect of the medial femoral condyle.[ijri.org]

Etiology

  • There is strong male over-representation presumably as a result of the predominantly sport related etiology.[radiopaedia.org]
  • Imaging will help the clinician confirm the clinical diagnosis and exclude other etiologies (Figs. 20.2 and 20.3 ). Fig. 20.2 ( a ) Longitudinal ultrasound obtained over the medial popliteal space shows a Baker cyst ( BC ).[musculoskeletalkey.com]
  • Besides tennis leg, the usual etiologies include deep venous thrombosis, tear of the Achilles tendon, ruptured Baker cyst, arthritis, pyomyositis, abscess, infection, hematoma, bursitis, stress fracture, thrombophlebitis, aneurysm, arteriovenous malformation[ijri.org]
  • Multiple tendon ruptures of unknown etiology. Foot Ankle Spec 2013; 6 ( 5 ): 380–383. [ PubMed ] [ Google Scholar ] 21. Turmo-Garuz A.[ncbi.nlm.nih.gov]
  • Functionally, plantaris is not a major contributor and acts with gastrocnemius as both a flexor of the knee and a plantarflexor of the ankle. [9] Epidemiology/Etiology Muscle strains most commonly occur in bi-articular muscles such as the hamstrings,[physio-pedia.com]

Epidemiology

  • Functionally, plantaris is not a major contributor and acts with gastrocnemius as both a flexor of the knee and a plantarflexor of the ankle. [9] Epidemiology/Etiology Muscle strains most commonly occur in bi-articular muscles such as the hamstrings,[physio-pedia.com]
Sex distribution
Age distribution

Prevention

  • Patient has to rest for few days or week or walk with the help of crutches to prevent weight bearing on the affected leg. Soon after the injury, compression with ice is beneficial in reducing pain and swelling.[tandurust.com]
  • In addition to preventing serious outcomes, Plantar Fasciitis shoe inserts can speed recovery and prevent future injury. Ready to find the right treatment for your heel pain? Shop our orthotic solutions.[heelthatpain.com]
  • Prevention Most Achilles tendon injuries occur during sports and can be prevented. If you had an Achilles tendon problem in the past, it is especially important to try to prevent another injury. To help prevent injury, try to: Warm up and stretch.[northshore.org]
  • How to Prevent It If you’re not looking to get sidelined for three months or more (and really, who is?), the best thing you can do is prevent plantar fasciitis and partial plantar tears before they strike.[runnersworld.com]
  • Prevention To reduce your chance of developing Achilles tendon problems, follow these tips: Stretch and strengthen calf muscles. Stretch your calf until you feel a noticeable pull but not pain. Don't bounce during a stretch.[mayoclinic.org]

References

Article

  1. Kwak HS, Han YM, Lee SY, Kim KN, Chung GH. Diagnosis and follow-up US evaluation of ruptures of the medial head of the gastrocnemius (‘tennis leg’). Korean J Radiol. 2006;7(3):193–198.
  2. Bianchi S, Sailly M, Molini L. Isolated tear of the plantaris tendon: ultrasound and MRI appearance. Skeletal radiol. 2011;40(7):891–895.
  3. Spina AA. The plantaris muscle: anatomy, injury, imaging and treatment. J Can Chiropr Assoc. 2007;51(3):158–165.
  4. Delgado GJ, Chung CB, Lektrakul N, et al. Tennis leg: clinical US study of 141 patients and anatomic investigation of four cadavers with MR imaging and US. Radiology. 2002;224(1):112–119.
  5. Toulipolous S, Hershmann EB. Lower Leg Pain. Diagnosis and Treatment of Compartment Syndrome and other Pain Syndromes of the Leg. Sports Med. 1999;27(3):193–204.
  6. Hung CY, Chang KV, Ozcakar L. Ultrasound imaging of torn soleus muscle. PM R. 2015;7(10):1106–1107.
  7. Daftary A, Adler RS. Sonographic evaluation and ultrasound-guided therapy of the Achilles tendon. Ultrasound Q. 2009;25(3):103–110.
  8. Jamadar DA, Jacobson JA, Theisen SE, et al. Sonography of the Painful Calf: Differential Considerations. AJR. 2002;179(3):709–716.
  9. Helms CA, Fritz RC, Garvin GJ. Plantaris muscle injury: evaluation with MR imaging. Radiology. 1995;195(1):201–203.
  10. Leekam RN, Agur AM, McKee NH. Using Sonography to Diagnose Injury of Plantaris Muscles and Tendons. AJR. 1999;172(1):185–189.

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Last updated: 2019-07-11 20:55