Friday, August 29, 2008

Plantaris may be a cause of patellar pain !!!

The plantaris muscle has been given little attention from us. Our anatomy teachers have said that plantaris is a rudimentary muscle. The function is negligible. It is most commonly mentioned only when absent from a specimen. In a cadaveric study of 46 samples Freeman AJ et al found: the muscle conformed with standard descriptions (n = 26; 56.52%), was present but varied from previous descriptions (n = 14; 30.44%), or was absent (n = 6; 13.04%).
Standard origin and insertations are given below:
Origin: 1. lower part of the lateral supracondylar line of femur 2. oblique popliteal ligament of femur.
Insertion: long and thin muscle lies between gastrocnemius and solius. It crosses from lateral to medial side. It is inserted to posterior surface of calcanium, medial to tendocalcanium.
How the variation presentated in Freeman’s study?
The variations consisted of distinct interdigitations with the lateral head of the gastrocnemius muscle (n = 9; 19.57%) and a strong fibrous extension of the plantaris muscle to the patella (n = 5; 10.87%).
What is suggests?
1. The presence of interdigitations strengthen the argument that the plantaris muscle supplement the activity of the lateral head of the gastrocnemius muscle whereas the patellar extension suggests an involvement with patellofemoral dynamics and may play a role in the various presentations of patellofemoral pain syndrome.
2. According to me the posterior heel pain must also be reviewed and chances of enthesis pain arising from plantaris muscle must also be investigated.

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