The twisted structure of the fetal calcaneal tendon is already visible in the second trimester
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ORIGINAL ARTICLE
The twisted structure of the fetal calcaneal tendon is already visible in the second trimester Paweł Szaro1,2,3 · Grzegorz Witkowski3 · Bogdan Ciszek3 Received: 22 September 2020 / Accepted: 5 November 2020 © The Author(s) 2020
Abstract Introduction The progress in morphological science results from the greater possibilities of intra-pubic diagnosis and treatment of congenital disabilities, including the motor system. However, the structure and macroscopic development of the calcaneal tendon have not been investigated in detail. Studies on the adult calcaneal tendon showed that the calcaneal tendon is composed of twisted subtendons. This study aimed to investigate the internal structure of the fetal calcaneal tendon in the second trimester. Materials and methods Thirty-six fetuses fixed in 10% formaldehyde were dissected using the layer-by-layer method and a surgical microscope. Results The twisted structure of the calcaneal tendon was revealed in all specimens. The posterior layer of the calcaneal tendon is formed by the subtendon from the medial head of the gastrocnemius muscle. In contrast, the anterior layer is formed by the subtendon from the lateral head of the gastrocnemius muscle. The subtendon from the soleus muscle constitutes the anteromedial outline of the calcaneal tendon. The lateral outline of the calcaneal tendon is formed by the subtendon originating from the medial head of the gastrocnemius muscle. In contrast, the medial outline is formed by the subtendon from the soleus muscle. In most of the examined limbs, the plantaris tendon attached to the tuber calcanei was not directly connected to the calcaneal tendon. Conclusions The twisted structure of the subtendons of the fetal calcaneal tendon is already visible in the second trimester and is similar to that seen in adults. Keywords Calcaneal tendon · Fetus · Tendon · Gastrocnemius · Soleus · Development
Introduction Fetal diagnostics are developing that add to the progress in morphological knowledge. However, the structure of the fetal calcaneal tendon has not been revealed. Anatomic knowledge of the locomotor system is essential to diagnose congenital diseases and discover advanced intrauterine operation methods. Rotation of the calcaneal tendon fibers * Paweł Szaro [email protected] 1
Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80 Gothenburg, Sweden
2
Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
3
Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
influences surgical techniques for lengthening the calcaneal tendon, which can be indicated in more than 85% of cases [14, 17]. Failure of the surgery may result in balance difficulties or hyperextension of the knee joint, leading to further motor disability and deformations [13, 17]. In contrast to the adult calcaneal tendon, the twisted structure of the calcaneal tendon in fetuses has not
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