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Persistent pain in the Achilles mid-portion? Consider the plantaris tendon as a possible culprit!
  1. Hakan Alfredson1,2
  1. 1 Integrative Medical Biology, Umeå University, Umeå, Sweden
  2. 2 ISEH, UCLH, London, UK
  1. Correspondence to Professor Hakan Alfredson, Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, S-901 87 Umeå, Sweden; hakan.alfredson{at}

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The plantaris tendon can contribute to persistent pain in patients who present with what seems at first glance to be mid-portion Achilles tendinopathy.1–8 Clinicians should consider the plantaris tendon when evaluating painful Achilles tendon conditions, particularly those that are not responding to treatment.

Below are typical findings related to the history, clinical examination and imaging. A short treatment guide follows.

Clinical case

A patient presents with mid-portion Achilles tendon pain. Here are features that point to plantaris tendon involvement.


  • Typically the patient has pain in the Achilles mid-portion, complaining of most pain being located on the medial side of the Achilles tendon.

  • The symptoms are often worse when running uphill, running in soft terrain and running …

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  • Competing interests The author, Professor Alfredson, is the owner of the Alfredson clinic that provides the service described here. The outcome results in the treatment section are unpublished data from the author/surgeon.

  • Provenance and peer review Not commissioned; externally peer reviewed.