# Does the Anatomical Type of the Plantaris Tendon Influence the Management of Midportion Achilles Tendinopathy?

## TL;DR

This paper explores how the anatomical type of the plantaris tendon affects the treatment of midportion Achilles tendinopathy, using a classification system to improve diagnosis and outcomes.

## Contribution

The paper introduces a classification-based approach to individualized treatment of midportion Achilles tendinopathy.

## Key findings

- Types I and V of the plantaris tendon showed the highest benefit from surgical resection.
- Endoscopic approaches were effective for Types II and III, while Type IV responded well to conservative treatment.
- Type VI is often misdiagnosed and requires combined neurolysis for effective treatment.

## Abstract

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology.