{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:52:33Z","timestamp":1792792353326,"version":"4.5.0"},"reference-count":63,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,9,12]],"date-time":"2013-09-12T00:00:00Z","timestamp":1378944000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003407","name":"MIUR","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003407","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Anatomy"],"published-print":{"date-parts":[[2013,12]]},"abstract":"Abstract<\/jats:title>Although the plantar fascia (PF<\/jats:styled-content>) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF<\/jats:styled-content> is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF<\/jats:styled-content> macroscopic and microscopic properties and study how A<\/jats:styled-content>chilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF<\/jats:styled-content>. Specimens from each PF<\/jats:styled-content> were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI)<\/jats:styled-content> obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and\/or inflammation of the A<\/jats:styled-content>chilles tendon. The thickness of PF<\/jats:styled-content> and paratenon was assessed in the two groups and statistical analyses were conducted. The PF<\/jats:styled-content> is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of A<\/jats:styled-content>chilles tendon than to the A<\/jats:styled-content>chilles tendon, through the periosteum of the heel. The PF<\/jats:styled-content> extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF<\/jats:styled-content> was rich in hyaluronan, probably produced by fibroblastic\u2010like cells described as \u2018fasciacytes\u2019. Nerve endings and P<\/jats:styled-content>acini and R<\/jats:styled-content>uffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF<\/jats:styled-content> in the proprioception of foot. In the radiological study, 27 of the 52 MRI<\/jats:styled-content> showed signs of A<\/jats:styled-content>chilles tendon inflammation and\/or degeneration, and the PF<\/jats:styled-content> was 3.43\u00a0\u00b1\u00a00.48\u00a0mm thick (99%CI<\/jats:styled-content> and SD<\/jats:styled-content>\u00a0=\u00a00.95), as opposed to 2.09\u00a0\u00b1\u00a00.24\u00a0mm (99%CI<\/jats:styled-content>, SD<\/jats:styled-content>\u00a0=\u00a00.47) in the patients in which the MRI<\/jats:styled-content> revealed no A<\/jats:styled-content>chilles tendon diseases; this difference in thickness of 1.29\u00a0\u00b1\u00a00.57\u00a0mm (99%CI<\/jats:styled-content>) was statistically significant (P<\/jats:italic>\u00a0<\u00a00.001). In the group of 27\/52 patients with tendinopathies, the PF<\/jats:styled-content> was more than 4.5\u00a0mm thick in 5, i.e. they exceeded the threshold for a diagnosis of plantar fasciitis. None of the other 25\/52 paitents had a PF<\/jats:styled-content> more than 4\u00a0mm thick. There was a statistically significant correlation between the thicknesses of the PF<\/jats:styled-content> and the paratenon. These findings suggest that the plantar fascia has a role not only in supporting the longitudinal arch of the foot, but also in its proprioception and peripheral motor coordination. Its relationship with the paratenon of the A<\/jats:styled-content>chilles tendon is consistent with the idea of triceps surae structures being involved in the PF<\/jats:styled-content> pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF<\/jats:styled-content> points to the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis.<\/jats:p>","DOI":"10.1111\/joa.12111","type":"journal-article","created":{"date-parts":[[2013,9,13]],"date-time":"2013-09-13T03:19:49Z","timestamp":1379042389000},"page":"665-676","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":223,"title":["Plantar fascia anatomy and its relationship with A<\/scp>chilles tendon and paratenon"],"prefix":"10.1111","volume":"223","author":[{"given":"Carla","family":"Stecco","sequence":"first","affiliation":[{"name":"Department of Molecular Medicine University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Corradin","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of Padua Padova Italy"},{"name":"Department of Surgery Oncology and Gastroenterology DiSCOG Orthopedic Clinic University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Macchi","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Morra","sequence":"additional","affiliation":[{"name":"Euganea Medica Center Albignasego Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Porzionato","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Biz","sequence":"additional","affiliation":[{"name":"Department of Surgery Oncology and Gastroenterology DiSCOG Orthopedic Clinic University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaele","family":"De Caro","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine University of Padua Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110079801900207"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199706000-00031"},{"key":"e_1_2_8_4_1","first-page":"335","article-title":"Ledderhose's disease","volume":"39","author":"Bardelli M","year":"1991","journal-title":"Arch Putti Chir Organi Mov"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7580.2008.01011.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200003)43:3<576::AID-ANR14>3.0.CO;2-A"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2004.01.017"},{"key":"e_1_2_8_8_1","first-page":"77","article-title":"Plantar fasciitis and the windlass mechanism: a biomechanical link to clinical practice","volume":"39","author":"Bolgla LA","year":"2004","journal-title":"J Athl Train"},{"key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/1071100712459173","article-title":"Relationship between tightness of the posterior muscles of the lower limb and plantar fasciitis","volume":"34","author":"Bol\u00edvar YA","year":"2013","journal-title":"Foot Ankle Int"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110070002100104"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-199315050-00006"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0105-2896.2009.00854.x"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20903"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61160-9"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.1999.29.12.756"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-012-1743-y"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.0507"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker522"},{"key":"e_1_2_8_19_1","volume-title":"Terminologia Anatomica: International Anatomical Terminology","author":"FCAT","year":"1998"},{"key":"e_1_2_8_20_1","first-page":"1","article-title":"Second international fascia research congress","volume":"2","author":"Findley TW","year":"2009","journal-title":"Int J Ther Massage Bodywork"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2008.11.013"},{"key":"e_1_2_8_22_1","first-page":"163","article-title":"Microcirculation of the Achilles tendon and significance of the paratenon. 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