The aim of this work was to focus on the macroscopic and microscopic properties of the planta fascia (PF) and study how diseases of the Achilles tendon might affect it. PF was isolated from twelve feet of unembalmed human cadavers, and specimens were tested with various histological and immunohistochemical stains. In a second stage, fifty-two magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle/foot pain were analyzed and divided based on the presence of signs of Achilles tendon pathologies. The dissections showed that PF is more closely connected to the paratenon of the Achilles tendon than to the Achilles tendon, through the periosteum of the heel. Under microscopical analysis, the PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as ‘fasciacytes’ and nerve endings; Pacini and Ruffini corpuscles were present. In the radiological study, 27/52 MRI showed signs of Achilles tendon pathology, and the PF was 3.43±0.48 mm thick, as opposed to 2.09±0.24 mm of the control group, with a statistically significant difference (P<0.001). There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that PF has a role in proprioception and peripheral motor coordination of the foot. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF indicates the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis.

Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.

BIZ, CARLO;CORRADIN, MARCO;STECCO, CARLA;DE CARO, RAFFAELE;IACOBELLIS, CLAUDIO
2014

Abstract

The aim of this work was to focus on the macroscopic and microscopic properties of the planta fascia (PF) and study how diseases of the Achilles tendon might affect it. PF was isolated from twelve feet of unembalmed human cadavers, and specimens were tested with various histological and immunohistochemical stains. In a second stage, fifty-two magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle/foot pain were analyzed and divided based on the presence of signs of Achilles tendon pathologies. The dissections showed that PF is more closely connected to the paratenon of the Achilles tendon than to the Achilles tendon, through the periosteum of the heel. Under microscopical analysis, the PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as ‘fasciacytes’ and nerve endings; Pacini and Ruffini corpuscles were present. In the radiological study, 27/52 MRI showed signs of Achilles tendon pathology, and the PF was 3.43±0.48 mm thick, as opposed to 2.09±0.24 mm of the control group, with a statistically significant difference (P<0.001). There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that PF has a role in proprioception and peripheral motor coordination of the foot. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF indicates the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis.
2014
ABSTRACT Background: The aim of this study was to investigate the role of foot fasciae and of the connective tissue sheath of the intermetatarsal plantar nerves (IPN) in the pathogenesis and clinical presentation of Civinini-Morton’s metatarsalgia. Materials and methods: ten not-embalmed feet were dissected in order to analyze the relationships of the IPN with the deep transverse metatarsal ligament (DTML) and with the fasciae of the foot. For each foot, samples of the nerve with all surrounding connective tissue were taken for hystological analysis. Finally, 30 MRI and 10 dynamic US were used to evaluate the aspect of the perineural connective tissue in patients with Civini-Morton’s syndrome and healthly people. Results: The data confirms that the bifurcation of the common digital nerve of the foot in the second and third webspace is always distal to the DTML. Around the nerve, concentric layers of fibrous and loose connective tissue create a protection for the nerve. This arrangement of the perineural tissue may be compared to a "telescope" and may allow compliance between nerve and foot during walking. In patients, the perineural connective tissue appears altered; in particular, it first shows perineural edema, followed by hyalinization and sclerosis. Perineural vessels undergo gradual sclerosis. Cell proliferation, with the appearance of neuroma, is only the last step. Discussion: Clinically, a thickening of fibrosis of the perineural connective tissue could decrease this "sliding system," exposing the nerve to mechanical effects of load during walking and causing the symptoms.
10th EFAS Congress
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11577/3021126
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