Universidad de Murcia. Departamento de Biología Celular e Histología
Abstract
Background/Aim. In a condition of pain in
the Achilles tendon insertion there are multiple
structures involved, such as the Achilles tendon itself,
the retrocalcaneal bursa and a bony protrusion at the
calcaneal tuberosity called Haglund’s deformity. The
innervation patterns of these structures are scarcely
described, and the subcutaneous calcaneal bursa is
traditionally not considered to be involved in the
pathology. This study aimed at describing the
innervation patterns of the four structures described
above to provide a better understanding of possible
origins of pain at the Achilles tendon insertion. Methods.
Biopsies were taken from 10 patients with insertional
Achilles tendinopathy, which had pathological changes
in the subcutaneous and retrocalcaneal bursae, a
Haglund deformity and Achilles tendon tendinopathy as
verified by ultrasound. The biopsies were stained using
immunohistochemistry in order to delineate the
innervation patterns in the structures involved in
insertional Achilles tendinopathy. Results. Immunohistochemical examinations found that the subcutaneous
bursa scored the highest using a semi-quantitative
evaluation of the degree of innervation when compared
to the retrocalcaneal bursa, the Achilles tendon, and the
calcaneal bone. Conclusions. These findings suggest that
the subcutaneous bursa, which is traditionally not
included in surgical treatment, may be a clinically
important factor in insertional Achilles tendinopathy