Surgical plantaris tendon removal for patients with plantaris tendon-related pain only and a normal Achilles tendon: a case series.

Objective: Surgical removal of the plantaris tendon can cure plantaris-associated Achilles tendinopathy, a condition in which Achilles and plantaris tendinopathy coexist. However, rare cases with plantaris tendinopathy alone are often misdiagnosed due to a normal Achilles tendon.

Methods: Prospective case series study at one centre. Methods: Ten consecutive patients (9 men and one woman, mean age 35 years, range 19-67) with plantaris tendon-related pain alone in altogether 13 tendons were included. All had had a long duration (median 10 months, range 3 months to 10 years) of pain symptoms on the medial side of the Achilles tendon mid-portion. Preoperative ultrasound showed thickened plantaris tendon but a normal Achilles tendon. Methods: Operative treatment consisting of ultrasound-guided excision of the plantaris tendon. Methods: Scores from Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A)were taken preoperatively and postoperatively (median duration 10 months). Patient satisfaction and time until full return to sports activity level was asked by a questionnaire.

Results: The VISA-A scores increased from 61 (range 45-81) preoperatively to 97 (range 94-100) postoperatively (p<0.01). Follow-up results at 10 months (range 7-72 months) on 9/10 patients showed full satisfaction and return to their preinjury sports or recreational activity.

Conclusions: The plantaris tendon should be kept in mind when evaluating painful conditions in the Achilles tendon region, especially when no Achilles tendinopathy is present. Excision of the plantaris tendon via a minor surgical procedure in local anaesthesia results in a good outcome.