Objectives Chronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy. Methods Ninety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement. Results In 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients. Conclusion Plantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness. Level of evidence IV case series.

中文翻译：

---

慢性疼痛性插入性跟腱病跖肌腱受累的超声和外科检查：病例系列

目的 众所周知，慢性疼痛性插入性跟腱病难以治疗。诊断并不总是容易的，因为可能涉及多个不同的组织。跖肌腱最近被描述为经常参与慢性疼痛的中部跟腱病。本研究旨在评估慢性疼痛性插入性跟腱病患者可能的跖肌腱受累。方法 连续 99 例患者（74 名男性，25 名女性），平均年龄为 40 岁（范围 24-64 岁），因插入性跟腱病接受了手术治疗。临床检查、超声（US）+多普勒检查和手术结果用于评估跖肌腱受累情况。结果 在 48/99 名患者中，有跖腱受累的临床症状，在跟腱止点内侧有疼痛和压痛。在所有这些病例中，手术结果显示跖肌腱粗而宽，跖肌和跟腱之间有丰富的血管化脂肪浸润。美国检查怀疑 32/48 患者跖部受累。结论 跖肌腱受累可能是慢性疼痛性插入性跟腱病病理的一部分，当出现明显的局灶性内侧疼痛和压痛时应考虑进行诊断和治疗。证据级别 IV 案例系列。手术结果显示跖肌腱粗而宽，跖肌和跟腱之间有丰富的血管化脂肪浸润。美国检查怀疑 32/48 患者跖部受累。结论 跖肌腱受累可能是慢性疼痛性插入性跟腱病病理的一部分，当出现明显的局灶性内侧疼痛和压痛时应考虑进行诊断和治疗。证据级别 IV 案例系列。手术结果显示跖肌腱粗而宽，跖肌和跟腱之间有丰富的血管化脂肪浸润。美国检查怀疑 32/48 患者跖部受累。结论 跖肌腱受累可能是慢性疼痛性插入性跟腱病病理的一部分，当出现明显的局灶性内侧疼痛和压痛时应考虑进行诊断和治疗。证据级别 IV 案例系列。结论 跖肌腱受累可能是慢性疼痛性插入性跟腱病病理的一部分，当出现明显的局灶性内侧疼痛和压痛时应考虑进行诊断和治疗。证据级别 IV 案例系列。结论 跖肌腱受累可能是慢性疼痛性插入性跟腱病病理的一部分，当出现明显的局灶性内侧疼痛和压痛时应考虑进行诊断和治疗。证据级别 IV 案例系列。