Erika Yokoyama

The twisted structure of the human Achilles tendon

The Achilles tendon (AT) consists of fascicles that originate from the medial head of the gastrocnemius (MG), lateral head of the gastrocnemius (LG), and soleus muscle (Sol). These fascicles are reported to have a twisted structure. However, there is no consensus as to the degree of torsion. The purpose of this study was to investigate the twisted structure of the AT at the level of fascicles that originate from the MG, LG, and Sol, and elucidate the morphological characteristics. Gross anatomical study of 60 Japanese cadavers (111 legs) was used. The AT fascicles originated from the MG, LG, and Sol were fused while twisting among themselves. There were three classification types depending on the degree of torsion. Further fine separation of each fascicle revealed MG ran fairly parallel in all types, whereas LG and Sol, particularly of the extreme type, were inserted onto the calcaneal tuberosity with strong torsion. In addition, the sites of Sol torsion were 3–5 cm proximal to the calcaneal insertion of the AT. These findings provide promising basic data to elucidate the functional role of the twisted structure and mechanisms for the occurrence of AT injury and other conditions.

Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome.

Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender‐based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender‐based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi‐square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender‐based anatomical differences.

Structure of the Achilles tendon at the insertion on the calcaneal tuberosity

Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results.

Anatomical study of toe flexion by flexor hallucis longus.

Because connections exist between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL), the FHL is surmised to exert a flexion action on the lesser toes, but this has not been studied quantitatively. The objectives of this study have thus been to clarify the types of FHL and FDL connections and branching, and to deduce the toe flexion actions of the FHL. One hundred legs from 55 cadavers were used for the study, with FHLs and FDLs harvested from the plantar aspect of the foot, and connections and branches classified. Image-analysis software was then used to analyze cross-sectional areas (CSAs) of each tendon, and the proportion of FHL was calculated in relation to flexor tendons of each toe. Type I (single slip from FHL to FDL tendon) was seen in 86 legs (86%), Type II (crossed connection) in 3 legs (3%), and Type III (single slip from FDL to FHL tendon) or Type IV (no connection between muscles) in 0 legs (0%). In addition, Type V (double slip from FHL to FDL tendon) was seen in 11 legs (11%), representing a new type not recorded in previous classifications. In terms of the various flexor tendons, the proportion of FHL showing tendons to toes 2 and 3 was high, at approximately 50-70%. Consequently, considering the branching type and proportion of CSA, the FHL was conjectured to not only act to flex the hallux, but also play a significant role in the flexion of toes 2 and 3. These results offer useful information for future clarification of the functional roles of tendinous slips from the FHL.

Coordination among the rearfoot, midfoot, and forefoot during walking

BackgroundExamining coordination between segments is essential for prevention and treatment of injuries. However, traditional methods such as ratio, cross-correlation technique, and angle-time plot may not provide a complete understanding of intersegmental coordination. The present study aimed to quantify the coordination among the rearfoot, midfoot, and forefoot segments during walking.MethodsTwenty healthy young men walked barefoot on a treadmill. Reflective markers were fixed to their right shank and foot based on the Leardini foot model. Three-dimensional joint angles were calculated at the distal segment, and were expressed relative to the adjacent proximal segment. The coupling angle representing intersegmental coordination was calculated by using the modified vector coding technique, and categorized into the following four coordination patterns: in-phase with proximal dominancy, in-phase with distal dominancy, tanti-phase with proximal dominancy, and anti-phase with distal dominancy.ResultsThe results showed that the midfoot was dominantly everted compared with the rearfoot and forefoot during the early stance (i.e., the rearfoot-midfoot coordination and midfoot-forefoot coordination were mainly in-phase with distal and proximal dominancy, respectively).ConclusionThis result may suggest that the midfoot plays a more significant role than the rearfoot and forefoot during early stance. The results of the present study can help in understanding the interaction of the intersegmental foot kinematic time series during walking. The results could be used as data to distinguish the presence of injuries or abnormal inter-segmental foot motions such as pes planus. Additionally, these data might be used in the future in a comparison with data on foot deformities.

Quantifying coordination among the rearfoot, midfoot, and forefoot segments during running

Abstract Because previous studies have suggested that there is a relationship between injury risk and inter-segment coordination, quantifying coordination between the segments is essential. Even though the midfoot and forefoot segments play important roles in dynamic tasks, previous studies have mostly focused on coordination between the shank and rearfoot segments. This study aimed to quantify coordination among rearfoot, midfoot, and forefoot segments during running. Eleven healthy young men ran on a treadmill. The coupling angle, representing inter-segment coordination, was calculated using a modified vector coding technique. The coupling angle was categorised into four coordination patterns. During the absorption phase, rearfoot–midfoot coordination in the frontal planes was mostly in-phase (rearfoot and midfoot eversion with similar amplitudes). The present study found that the eversion of the midfoot with respect to the rearfoot was comparable in magnitude to the eversion of the rearfoot with respect to the shank. A previous study has suggested that disruption of the coordination between the internal rotation of the shank and eversion of the rearfoot leads to running injuries such as anterior knee pain. Thus, these data might be used in the future to compare to individuals with foot deformities or running injuries.

Changes in Kinematic Coupling Among the Rearfoot, Midfoot, and Forefoot Segments During Running and Walking

BACKGROUND Understanding the concept of kinematic coupling is essential when selecting the appropriate therapeutic strategy and grasping mechanisms for the occurrence of injuries. A previous study reported that kinematic coupling between the rearfoot and shank during running and walking were different. However, because foot mobility involves not only the rearfoot but also the midfoot or forefoot, kinematic coupling is likely to occur among the rearfoot, midfoot, and forefoot segments. We investigated changes in kinematic coupling among the rearfoot, midfoot, and forefoot segments during running and walking. METHODS Ten healthy young men were instructed to run (2.5 ms-1) and walk (1.3 ms-1) on a treadmill at speeds set by the examiner. The three-dimensional joint angles of the rearfoot, midfoot, and forefoot were calculated based on the Leardini foot model Kinematic coupling was evaluated with the absolute value of the cross-correlation coefficients and coupling angles obtained by using a vector coding technique. RESULTS The cross-correlation coefficient between rearfoot eversion/inversion and midfoot dorsiflexion/plantarflexion was significantly higher during running ( r = 0.79) than during walking ( r = 0.58), suggesting that running requires stronger kinematic coupling between rearfoot eversion/inversion and midfoot plantarflexion/dorsiflexion than walking. Furthermore, the coupling angle between midfoot eversion/inversion and forefoot eversion/inversion was significantly less during running (30.0°) than during walking (40.7°) ( P < .05). Hence, the magnitude of midfoot frontal plane excursion during running was greater than that during walking. CONCLUSIONS Excessive rearfoot eversion during running is likely to lead to excessive midfoot dorsiflexion, and such abnormal kinematic coupling between the rearfoot and midfoot may be associated with mechanisms for the occurrence of injuries.

Estimation of Bone-on-Bone Forces at the Tibiofemoral Joint during Forward and Backward Stair Descent

Objective: Backward stair descent has attracted attention from the viewpoint of injury prevention. Previous studies have shown that knee extension moment is lower during the backward stair descent than during the forward stair descent. However, it remains unclear whether the bone-on-bone force at the tibiofemoral joint differs between the two stair descent methods. The purpose of this study was to estimate bone-on-bone forces at the tibiofemoral joint during forward and backward stair descent. Methods: Six healthy young men participated in this study. The stair descents were performed in the forward and backward direction using a step-by-step pattern. The muscle tensions of the lower limbs were estimated based on the net joint moments and information provided by the electromyography. The bone-on-bone forces at the tibiofemoral joint were calculated based on the estimated muscle tensions and geometry of limbs. Results: While the knee extension moments were significantly lower during backward stair descent than forward stair descent, the estimated bone-on-bone forces at the tibiofemoral joint in two different descending methods showed no significant difference. The quadriceps femoris tension during backward stair descent was significantly lower than that during forward stair descent. Conclusions: The bone-on-bone forces reflect mechanical load to the articular surface. Thus, the results of this study suggested that the load of tibiofemoral articular surface remains unchanged between the forward and backward stair descent. However, backward stair descent might be a relevant method for reduction of quadriceps femoris tensions.