Calcaneal morphology and plantar fasciitis

NewsBot · Nov 9, 2022

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ACHILLES TENDINOPATHY AND PLANTAR FASCIOPATHY: ARE WE IGNORING CALCANEAL BONE MORPHOLOGY? – A RADIOLOGICAL ASSESSMENT OF CALCANEAL PARAMETERS
KailashDevalia et al
The Foot; 4 November 2022, 101950

Highlights
•Achilles tendinopathy (AT) and Plantar Fasciopathy (PF) are difficult conditions to treat.
•Conservative and operative treatments have been tried with varying results.
•Our study is aimed at investigating the role of altered calcaneal morphology and its effect on development of AT & PF.
•The increased distance of Achilles tendon and plantar fascia attachments on the calcaneus due to its altered morphology produces high tensile stresses within these structures and predisposes to degenerations and tears.
•We suggest the future role of modified block resection calcaneal osteotomy for recalcitrant disease.
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Background
We conducted a radiological study to determine whether calcaneal morphological differences contribute to the pathophysiology of Achilles tendinopathy and plantar fasciopathy. This study is aimed to support our new hypothesis to explain the pathophysiology leading to recalcitrant disease and also to identify the role of calcaneal osteotomy for treating these conditions.

Materials and Methods
Calcaneal width and height distance deviation from center of ankle joint rotation was measured on standardized lateral weight bearing Ankle radiographs. A comparison was made between control group and study group to identify the differences in measured parameters.

Results
Significant difference (P = 0.05) was observed in calcaneal width distance in study group with Achilles tendinopathy. In Plantar fasciopathy the vertical distance was reduced suggesting flattening of arch in study group. However, the difference was not statistically significant.

Conclusion
The study identifies the importance of evaluating calcaneal morphology for patients with recalcitrant Achilles tendinopathy and plantar fasciopathy. We propose a new hypothesis to explain the high stresses produced in entire Achilles –calcaneus –plantar fascia unit which leads to chronic inflammatory response and intra substance degeneration.
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