An ossifying bridge – on the structural continuity between the Achilles tendon and the plantar fascia

Zwirner, Johann; Zhang, Ming; Ondruschka, Benjamin; Akita, Keichi; Hammer, Niels

doi:10.1038/s41598-020-71316-z

Cited by 23 publications

(28 citation statements)

References 21 publications

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“…This thin fibrous band connects the plantar heel to the metatarsophalangeal joints [2]. PF is thought to be attached to the Achilles tendon via the superficial aligned trabeculae of the calcaneus, even if the continuity of collagen fibers between the Achilles tendon and the PF through the calcaneus is still debated [3]. PF has a fundamental biomechanical role in supporting the medial longitudinal arch of the foot [4][5][6] and is capable of storing strain energy and converting it into propulsive force, behaving as a quasi-elastic tissue [7], but it is in general characterized by relevant viscoelastic behavior [8].…”

Section: Introductionmentioning

confidence: 99%

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Experimental Analysis of Plantar Fascia Mechanical Properties in Subjects with Foot Pathologies

et al. 2021

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Plantar Fascia (PF) is a fibrous tissue that plays a key role in supporting the foot arch; it can be affected by several pathologies that can alter foot biomechanics. The present study aims at investigating the mechanical behavior of PF and evaluating possible correlations between mechanical properties and specific pathologies, namely diabetes and plantar fibromatosis (Ledderhose syndrome). PF samples were obtained from 14 human subjects, including patients with Ledderhose syndrome, patients affected by diabetes and healthy subjects. Mechanical properties of PF tissues were evaluated on three samples from each subject, by cyclic uniaxial tensile tests up to 10% of maximum strain and stress relaxation tests for 300 s, in hydrated conditions at room temperature. In tensile tests, PF exhibits non-linear stress–strain behavior, with a higher elastic modulus (up to 25–30 MPa) in patients affected by Ledderhose syndrome and diabetes with respect to healthy subjects (elastic modulus 10 ÷ 14 MPa). Stress-relaxation tests show that PF of patients affected by Ledderhose syndrome and diabetes develop more intense viscous phenomena. The results presented in this work represent the first experimental data on the tensile mechanical propertied of PF in subjects with foot diseases and can provide an insight on foot biomechanics in pathological conditions.

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Section: Introductionmentioning

confidence: 99%

“…Few works in the literature have been carried out on the experimental testing of the mechanical properties of PF [3,8,22]; moreover, the possible effects of structural impairments on the mechanical behavior of fascia are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Experimental Analysis of Plantar Fascia Mechanical Properties in Subjects with Foot Pathologies

et al. 2021

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“…A number of studies have found a biomechanical link between the AT and PF by measuring the load-deformation properties in the PF under various conditions of the AT [5][6][7][8] . This biomechanical link provides grounds for hypothesizing that there is continuity between the AT and PF 9 . Indeed, some authors have described a lifelong continuity between the two structures [10][11][12] whilst others only agree of the continuity being in a fetal or neonatal population 13,14 , and others concluding that the connection ceases by late adulthood 15 .…”

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confidence: 95%

On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study

Singh

Zwirner

Templer

et al. 2021

Sci Rep

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Current treatments of plantar fasciitis are based on the premise that the Achilles tendon (AT) and plantar fascia (PF) are mechanically directly linked, which is an area of debate. The aim of this study was to assess the morphological relationship between the AT and PF. Nineteen cadaveric feet were x-ray imaged, serially sectioned and plastinated for digital image analyses. Measurements of the AT and PF thicknesses and cross-sectional areas (CSA) were performed at their calcaneal insertion. The fiber continuity was histologically assessed in representative subsamples. Strong correlations exist between the CSA of the AT and PF at calcaneal insertion and the CSA of PF’s insertional length (r = 0.80), and between the CSAs of AT’s and PF’s insertional lengths. Further correlations were observed between AT and PF thicknesses (r = 0.62). This close morphological relationship could, however, not be confirmed through x-ray nor complete fiber continuity in histology. This study provides evidence for a morphometric relationship between the AT and PF, which suggests the presence of a functional relationship between these two structures following the biological key idea that the structure determines the function. The observed morphological correlations substantiate the existing mechanical link between the AT and PF via the posterior calcaneus and might explain why calf stretches are a successful treatment option for plantar heel pain.

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“…Future studies may add to these findings, examining tissues right after death without deep-freezing in comparison, thereby exploring the effects of deep-freezing on the here investigated biomechanical properties of the human TMF. Preconditioning of biological tissues for the aforementioned purposes is commonly done in tensile testing protocols as performed here 52 – 54 . However, the detailed effect of preconditioning on the biomechanical properties of biological tissues yet remains to be investigated in detail.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical characterization of human temporal muscle fascia in uniaxial tensile tests for graft purposes in duraplasty

Zwirner

Ondruschka

Scholze

et al. 2021

Sci Rep

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The human temporal muscle fascia (TMF) is used frequently as a graft material for duraplasty. Encompassing biomechanical analyses of TMF are lacking, impeding a well-grounded biomechanical comparison of the TMF to other graft materials used for duraplasty, including the dura mater itself. In this study, we investigated the biomechanical properties of 74 human TMF samples in comparison to an age-matched group of dura mater samples. The TMF showed an elastic modulus of 36 ± 19 MPa, an ultimate tensile strength of 3.6 ± 1.7 MPa, a maximum force of 16 ± 8 N, a maximum strain of 13 ± 4% and a strain at failure of 17 ± 6%. Post-mortem interval correlated weakly with elastic modulus (r = 0.255, p = 0.048) and the strain at failure (r = − 0.306, p = 0.022) for TMF. The age of the donors did not reveal significant correlations to the TMF mechanical parameters. Compared to the dura mater, the here investigated TMF showed a significantly lower elastic modulus and ultimate tensile strength, but a larger strain at failure. The human TMF with a post-mortem interval of up to 146 h may be considered a mechanically suitable graft material for duraplasty when stored at a temperature of 4 °C.

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An ossifying bridge – on the structural continuity between the Achilles tendon and the plantar fascia

Cited by 23 publications

References 21 publications

Experimental Analysis of Plantar Fascia Mechanical Properties in Subjects with Foot Pathologies

Experimental Analysis of Plantar Fascia Mechanical Properties in Subjects with Foot Pathologies

On the morphological relations of the Achilles tendon and plantar fascia via the calcaneus: a cadaveric study

Biomechanical characterization of human temporal muscle fascia in uniaxial tensile tests for graft purposes in duraplasty

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