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Isolated Rupture of the Distal Plantaris Muscle
ARTICLE IN PRESS The Journal of Foot & Ankle Surgery ■■ (2017) ■■–■■
Contents lists available at ScienceDirect
The Journal of Foot & Ankle Surgery j o u r n a l h o m e p a g e : w w w. j f a s . o r g
Case Reports and Series
Isolated Rupture of the Distal Plantaris Muscle Benjamin Zickmantel Jr., MD 1, Fabian Krause, MD 2, Lars Frauchiger, MD 1 1Orthopedic 2Orthopedic
Surgeon, Department of Orthopaedic Surgery and Traumatology, Spital STS AG Thun, Thun, Switzerland Surgeon, Department of Orthopaedic Surgery and Traumatology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
A R T I C L E
I N F O
Level of Clinical Evidence: 4
Keywords: Achilles tendon musculus gastrocnemius musculus plantaris tendon rupture
A B S T R A C T
In the present case, the plantaris tendon was ruptured in isolation and at the distal part of the tendon. An injury of the Achilles tendon, gastrocnemius muscle, or soleus muscle was not detected. To the best of our knowledge, a similar case has not yet been reported. Our case basically demonstrates that a rupture of the musculus plantaris does not have to occur at the myotendiouns junction or the muscle belly itself. The initial nonoperative treatment with physiotherapy, antiinflammatory medicine, and an early return to sports, even for this more distal plantaris tendon rupture, led to a good result. © 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
A 29-year-old professional soccer player presented with complete rupture of the distal part of the right musculus plantaris during a soccer match with the Achilles tendon staying intact. Conservative treatment resulted in a return to full sports activity after 4 weeks. To the best of our knowledge, this is the first reported case of isolated distal rupture of the musculus plantaris tendon.
allowed to return to practice with full weightbearing and full range of motion, except for not performing stop-and-go movements. A full recovery and a return to professional soccer was achieved by 4 weeks after the injury. The patient had not developed a recurrence at the 2-year follow-up examination, and he was symptom free.
Case Report
Discussion
A 29-year-old professional soccer player was referred to our clinic because of an injury that had occurred during a soccer match. He complained of a sudden pain at the medial insertion of the right Achilles tendon after a stop-and-go movement in dorsiflexion of the right hindfoot. He did not recall a previous injury or any prodromes. Examination showed no pathologic findings of the right lateral Achilles tendon. Symmetrical spontaneous hindfoot plantarflexion in the prone position was possible, and the Thompson test findings were negative. However, the medial part of the Achilles tendon was tender on palpation at ~2 to 3 cm proximal to the insertion and demonstrated mild swelling. Magnetic resonance imaging confirmed rupture of the distal part of the musculus plantaris tendon about 3.5 cm proximal to the calcaneus, with the Achilles tendon uninjured (Fig.). We started an immediate conservative treatment regimen with pain relief with nonsteroidal antiinflammatory medication and calf muscle stretching exercises. The patient was immediately
Acute ruptures of the musculus plantaris tendon have been previously reported in the published data (1–3). They can be associated with a tear of the gastrocnemius or soleus muscle (1). An injury to the gastrocnemius muscle, soleus muscle, or Achilles tendon can be related to a plantaris tear. The location of the rupture has been described at the myotendinous junction. Helms et al (2) described 15 cases of rupture or strain of the plantaris muscles evaluated using magnetic resonance imaging were treated with rest, ice, and antiinflammatory medications (2). They concluded that rupture of the plantaris muscle can occur at the myotendinous junction in the upper part of the calf, with or without an associated hematoma. Next to this, a strain of the more proximal muscle belly of the plantaris muscle can occur (1). A rupture of the plantaris muscle can be associated with a tear of the anterior cruciate ligament, rupture of the medial head of the gastrocnemius muscle, or rupture of the Achilles tendon (1–3). More recently, Gopinath et al (1) reported 2 cases of musculus plantaris rupture, 1 with a similar location at the musculotendinous junction with associated proximal retraction of the torn end, and 1 case with rupture of the mid and proximal part, both of which were associated with a grade 1 injury of the gastrocnemius muscle in the calf (1). In the present case, the plantaris tendon was ruptured in isolation and at the distal part of the tendon. An injury of the Achilles
Financial Disclosure: None reported. Conflict of Interest: Dr. Krause reports a consultant/advisory role with Zimmer and Medid. Address correspondence to: Benjamin Zickmantel, Jr., MD, Altenbergstrasse 78, Bern 3013, Switzerland. E-mail address: [email protected] (B. Zickmantel).
1067-2516/$ - see front matter © 2017 by the American College of Foot and Ankle Surgeons. All rights reserved. https://doi.org/10.1053/j.jfas.2017.11.027
ARTICLE IN PRESS 2
B. Zickmantel et al. / The Journal of Foot & Ankle Surgery ■■ (2017) ■■–■■
Fig. Magnetic resonance imaging scan depicting the rupture of the distal part of the plantaris tendon.
tendon, gastrocnemius muscle, or soleus muscle was not detected. To the best of our knowledge, a similar case has not yet been reported. Our case basically demonstrates that a rupture of the musculus plantaris does not have to occur at the myotendinous junction or the muscle belly itself. The initial nonoperative treatment with physiotherapy, antiinflammatory medicine, and an early return to sports, even with this more distal plantaris tendon rupture, led to a good result.
References 1. Gopinath TN, Jagdish J, Krishnakiran K, Shaji PC. Rupture of plantaris muscle—a mimic: MRI findings. J Clin Imaging Sci 2:19, 2012. 2. Helms CA, Fritz RC, Garvin GJ. Plantaris muscle injury: evaluation with MR imaging. Radiology 195:201–203, 1995. 3. Spang C, Alfredson H, Docking SI, Masci L, Andersson G. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J 98-B:1312–1319, 2016.
Contents lists available at ScienceDirect
The Journal of Foot & Ankle Surgery j o u r n a l h o m e p a g e : w w w. j f a s . o r g
Case Reports and Series
Isolated Rupture of the Distal Plantaris Muscle Benjamin Zickmantel Jr., MD 1, Fabian Krause, MD 2, Lars Frauchiger, MD 1 1Orthopedic 2Orthopedic
Surgeon, Department of Orthopaedic Surgery and Traumatology, Spital STS AG Thun, Thun, Switzerland Surgeon, Department of Orthopaedic Surgery and Traumatology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
A R T I C L E
I N F O
Level of Clinical Evidence: 4
Keywords: Achilles tendon musculus gastrocnemius musculus plantaris tendon rupture
A B S T R A C T
In the present case, the plantaris tendon was ruptured in isolation and at the distal part of the tendon. An injury of the Achilles tendon, gastrocnemius muscle, or soleus muscle was not detected. To the best of our knowledge, a similar case has not yet been reported. Our case basically demonstrates that a rupture of the musculus plantaris does not have to occur at the myotendiouns junction or the muscle belly itself. The initial nonoperative treatment with physiotherapy, antiinflammatory medicine, and an early return to sports, even for this more distal plantaris tendon rupture, led to a good result. © 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
A 29-year-old professional soccer player presented with complete rupture of the distal part of the right musculus plantaris during a soccer match with the Achilles tendon staying intact. Conservative treatment resulted in a return to full sports activity after 4 weeks. To the best of our knowledge, this is the first reported case of isolated distal rupture of the musculus plantaris tendon.
allowed to return to practice with full weightbearing and full range of motion, except for not performing stop-and-go movements. A full recovery and a return to professional soccer was achieved by 4 weeks after the injury. The patient had not developed a recurrence at the 2-year follow-up examination, and he was symptom free.
Case Report
Discussion
A 29-year-old professional soccer player was referred to our clinic because of an injury that had occurred during a soccer match. He complained of a sudden pain at the medial insertion of the right Achilles tendon after a stop-and-go movement in dorsiflexion of the right hindfoot. He did not recall a previous injury or any prodromes. Examination showed no pathologic findings of the right lateral Achilles tendon. Symmetrical spontaneous hindfoot plantarflexion in the prone position was possible, and the Thompson test findings were negative. However, the medial part of the Achilles tendon was tender on palpation at ~2 to 3 cm proximal to the insertion and demonstrated mild swelling. Magnetic resonance imaging confirmed rupture of the distal part of the musculus plantaris tendon about 3.5 cm proximal to the calcaneus, with the Achilles tendon uninjured (Fig.). We started an immediate conservative treatment regimen with pain relief with nonsteroidal antiinflammatory medication and calf muscle stretching exercises. The patient was immediately
Acute ruptures of the musculus plantaris tendon have been previously reported in the published data (1–3). They can be associated with a tear of the gastrocnemius or soleus muscle (1). An injury to the gastrocnemius muscle, soleus muscle, or Achilles tendon can be related to a plantaris tear. The location of the rupture has been described at the myotendinous junction. Helms et al (2) described 15 cases of rupture or strain of the plantaris muscles evaluated using magnetic resonance imaging were treated with rest, ice, and antiinflammatory medications (2). They concluded that rupture of the plantaris muscle can occur at the myotendinous junction in the upper part of the calf, with or without an associated hematoma. Next to this, a strain of the more proximal muscle belly of the plantaris muscle can occur (1). A rupture of the plantaris muscle can be associated with a tear of the anterior cruciate ligament, rupture of the medial head of the gastrocnemius muscle, or rupture of the Achilles tendon (1–3). More recently, Gopinath et al (1) reported 2 cases of musculus plantaris rupture, 1 with a similar location at the musculotendinous junction with associated proximal retraction of the torn end, and 1 case with rupture of the mid and proximal part, both of which were associated with a grade 1 injury of the gastrocnemius muscle in the calf (1). In the present case, the plantaris tendon was ruptured in isolation and at the distal part of the tendon. An injury of the Achilles
Financial Disclosure: None reported. Conflict of Interest: Dr. Krause reports a consultant/advisory role with Zimmer and Medid. Address correspondence to: Benjamin Zickmantel, Jr., MD, Altenbergstrasse 78, Bern 3013, Switzerland. E-mail address: [email protected] (B. Zickmantel).
1067-2516/$ - see front matter © 2017 by the American College of Foot and Ankle Surgeons. All rights reserved. https://doi.org/10.1053/j.jfas.2017.11.027
ARTICLE IN PRESS 2
B. Zickmantel et al. / The Journal of Foot & Ankle Surgery ■■ (2017) ■■–■■
Fig. Magnetic resonance imaging scan depicting the rupture of the distal part of the plantaris tendon.
tendon, gastrocnemius muscle, or soleus muscle was not detected. To the best of our knowledge, a similar case has not yet been reported. Our case basically demonstrates that a rupture of the musculus plantaris does not have to occur at the myotendinous junction or the muscle belly itself. The initial nonoperative treatment with physiotherapy, antiinflammatory medicine, and an early return to sports, even with this more distal plantaris tendon rupture, led to a good result.
References 1. Gopinath TN, Jagdish J, Krishnakiran K, Shaji PC. Rupture of plantaris muscle—a mimic: MRI findings. J Clin Imaging Sci 2:19, 2012. 2. Helms CA, Fritz RC, Garvin GJ. Plantaris muscle injury: evaluation with MR imaging. Radiology 195:201–203, 1995. 3. Spang C, Alfredson H, Docking SI, Masci L, Andersson G. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J 98-B:1312–1319, 2016.