Advertisement

The Role of the Plantaris in Intramuscular Gastrocnemius Equinus Correction

      Abstract

      Equinus deformity is a common cause of foot and ankle pathology. The purpose of our study was to evaluate the role of the plantaris in equinus. Secondary aims were to describe the role of the plantaris in intramuscular gastrocnemius recession and to determine the prevalence of the plantaris in our patient population. We measured ankle dorsiflexion during the steps of a Baumann-type intramuscular gastrocnemius recession. Eighty-nine patients were enrolled in our study. Fourteen of 89 (15.7%) patients did not have a plantaris. A mean dorsiflexion of 9 (interquartile range 6-12)° was obtained after transection of the plantaris tendon and an additional mean 8 (interquartile range 5-10)° was obtained after recession of the gastrocnemius aponeurosis. There was a strong positive correlation (rs = 0.842) of dorsiflexion increase after plantaris transection and dorsiflexion increase after gastrocnemius recession (p < .00). Linear regression showed that for every one-degree of dorsiflexion increase with plantaris transection, there was a predicted dorsiflexion increase of 0.69° with gastrocnemius recession. These results indicate that the plantaris is a component of equinus deformity.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Spina AA.
        The plantaris muscle: anatomy, injury, imaging, and treatment.
        J Can Chiropr Assoc. 2007; 5: 158-165
        • Dalmau-Pastor M
        • Fargues-Polo B
        • Casanova-Martinez D
        • Vega J
        • Golano P.
        Anatomy of the triceps surae: a pictorial essay.
        Foot Ankle Clin N Am. 2014; 9: 603-635
        • 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. 2016; 98: 1312-1319
        • Olewnik L
        • Karauda P
        • Gonera B
        • Kurtys K
        • Tubbs RS
        • Paulsen F
        • Szymanski R
        • Polguj M.
        Impact of plantaris ligamentous tendon.
        Sci Rep. 2021; 11: 4550
        • Rohilla S
        • Jain N
        • Yadav R.
        Plantaris rupture: why is it important?.
        BMJ Case Rep. 2013; 2013bcr2012007840
        • Baggett B
        • Young G.
        Ankle joint dorsiflexion. Establishment of a normal range.
        J Am Podiatr Med Assoc. 1993; 83: 251-254
        • Charles J
        • Scutter S
        • Buckley J.
        Static ankle joint equinus toward a standard definition and diagnosis.
        J Am Podiatr Med Assoc. 2010; 100: 195-203
        • Houx L
        • Lempereur M
        • Remy-Neris O
        • Brochard S.
        Threshold of equinus which alters biomechanical gait parameters in children.
        Gait Posture. 2013; 38: 582-589
        • Chen L
        • Greisberg J.
        Achilles lengthening procedures.
        Foot Ankle Clin N Am. 2009; 14: 627-637
        • DeHeer PA
        • Standish SN
        • Kirchner KJ
        • Fleischer
        Prevalence and distribution of ankle joint eqnius in 249 consecutive patients attending a foot and ankle specialty clinic.
        J Am Podiatr Med Assoc. 2021; 111: 1-8
        • Baumann J
        • Koch H.
        Ventrale aponeurotische Verl¨angerung des musculus gastrocnemius.
        Operat Orthop Taumatol. 1989; 1: 254-258
        • Saraph V
        • Zwick E
        • Uitz C
        • Linhart W
        • Steinwender G.
        The Baumann procedure for fixed contracture of the gastrosoleus in cerebral palsy.
        J Bone Joint Surg (Br). 2000; 82: 535-540
        • DeHeer PA.
        Equinus and lengthening techniques.
        Clin Podiatr Med Surg. 2017; 34: 207-227
        • Firth GB
        • McMullan M
        • Chin R
        • Ma M
        • Selber P
        • Eizenberg N
        • Wolfe R
        • Graham HK.
        Lengthening of the gastrocnemius-soleus complex: An anatomical and biomechanical study in human cadavers.
        J Bone Joint Surg Am. 2013; 95: 1489-1496
        • Yammine K
        • Saghie S
        • Assi C.
        A meta-analysis of the surgical availability and morphology of the plantaris tendon.
        J Hand Surg. 2019; 24: 208-218
        • Greene BD
        • Smith SE
        • Smith JT.
        Snapping plantaris tendon: a rare case in a competitive dancer.
        J Am Acad Orthop Surg Glob. 2021; 5: 1-5
        • Rong K
        • Ge WT
        • Li XC
        • Xu XY.
        Mid-term results of intramuscular lengthening of gastrocnemius and/or soleus to correct equinus deformity in flatfoot.
        Foot Ankle Int. 2015; 36: 1223-1228
        • Svehlik M
        • Kraus T
        • Steinwender G
        • Zwick EB
        • Saraph V
        • Linhart WE.
        The Baumann procedure to correct equinus gait with diplegic cerebral palsy.
        J Bone Joint Surg Br. 2012; 94: 1143-1147