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      A Study on the Structure and Morphologic Development of Calcaneal Tendon and Triceps Surae Muscle in Human Fetuses during the Fetal Period and the Evaluation of Clinical Importance of Calcaneal Tendon Translated title: Estudio sobre la Estructura y Desarrollo Morfológico del Tendón Calcáneo y el Músculo Tríceps Sural en Fetos Humanos Durante el Período Fetal y Evaluación de la Importancia Clínica del Tendón Calcáneo

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          Abstract

          It was aimed that the morphometric development of calcaneal tendon and the structures building it up in human fetuses during the fetal period be anatomically studied and that its clinical importance be evaluated. The study comprised a total of 102 fetus legs (51 human fetuses: 26 male and 25 female) whose ages varied between 15-40 gestational week, without external pathology or anomaly. The fetuses were divided in groups according to gestational weeks, trimesters and months. In the wake of the general external measurements of fetuses, leg dissection was performed. Afterwards, the morphometric parameters of gastrocnemius muscle, soleus muscle and calcaneal tendon were measured. The averages and the standard deviations of the measured parameters were determined according to gestational weeks, trimesters and months. There was a significant correlation between the measured parameters and the gestational age (p<0.001). There was no difference between sexes in terms of parameters (p>0.005). All the obtained results were discussed by making a comparison between them and the previous studies made. We are of the opinion that the data obtained in our study will be of use to the involved clinicians in the evaluation of the development of calcaneal tendon and the structures constituting it during the fetal period and in clinical studies and applications as well.

          Translated abstract

          El objetivo de esta investigación consiste en el estudio del desarrollo morfométrico del tendón calcáneo y las estructuras que se desarrollan con él durante el período fetal humano y evaluar su importancia clínica. El estudio comprendió un total de 102 piernas de fetos (51 fetos humanos: 26 masculinos y 25 femeninos) cuyas edades variaron entre 15 a 40 semanas de edad gestacional, sin presencia de patología externa o anomalía. Los fetos fueron divididos en grupos de acuerdo con las semanas de gestación, trimestres y meses. Luego de realizar mediciones generales externas en los fetos, se procedió a la disección de las piernas. Se midieron parámetros morfométricos correspondientes a los músculos gastrocnemio, sóleo y tendón calcáneo. Los promedios y las desviaciones estándar de los parámetros medidos se determinaron de acuerdo a la edad gestacional de los fetos, en semanas trimestres y meses. Hubo una correlación significativa entre los parámetros medidos y la edad gestacional (p<0,001). No hubo diferencias entre los sexos en términos de parámetros (p>0,005). Todos los resultados obtenidos se discutieron haciendo una comparación entre ellos y los estudios previos realizados. Los datos obtenidos en nuestro estudio serán de utilidad para los médicos en la evaluación del desarrollo del tendón calcáneo y las estructuras que lo constituyen, durante el período fetal, para la utilización de este conocimiento en estudios clínicos y diversas aplicaciones.

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          Most cited references23

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          The anatomy of the Achilles tendon.

          The Achilles tendon is the strongest and largest tendon in the body. It is the conjoined tendon of the gastrocnemius and the soleus muscles, and may have a small contribution from the plantaris. The muscles and the Achilles tendon are in the posterior, superficial compartment of the calf. Through the Achilles tendon, they are the main plantar flexors of the ankle. The Achilles tendon is subjected to the highest loads in the body, with tensile loads up to ten times body weight during running, jumping, hopping, and skipping. This article discusses the anatomy of the Achilles tendon.
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            Development of the human Achilles tendon enthesis organ.

            The attachment of the Achilles tendon is part of an 'enthesis organ' that reduces stress concentration at the hard-soft tissue interface. The organ also includes opposing sesamoid and periosteal fibrocartilages, a bursa and Kager's fat pad. In addition, the deep crural and plantar fasciae contribute to Achilles stress dissipation and could also be regarded as components. Here we describe the sequence in which these various tissues differentiate. Serial sections of feet from spontaneously aborted foetuses (crown rump lengths 22-322 mm) were examined. All slides formed part of an existing collection of histologically sectioned embryological material, obtained under Spanish law and housed in the Universidad Complutense, Madrid. From the earliest stages, it was evident that the Achilles tendon and plantar fascia had a mutual attachment to the calcaneal perichondrium. The first components of the enthesis organ to appear (in the 45-mm foetus) were the retrocalcaneal bursa and the crural fascia. The former developed by cavitation within the mesenchyme that later gave rise to Kager's fat pad. The tip of the putative fat pad protruded into the developing bursa in the 110-mm foetus and fully differentiated adipocytes were apparent in the 17-mm foetus. All three fibrocartilages were first recognisable in the 332-mm foetus--at which time adipogenesis had commenced in the heel fat pad. The sequence in which the various elements became apparent suggests that bursal formation and the appearance of the crural fascia may be necessary to facilitate the foot movements that subsequently lead to fibrocartilage differentiation. The later commencement of adipogenesis in the heel than in Kager's pad probably reflects the non-weight environment in utero. The direct continuity between plantar fascia and Achilles tendon that is characteristic of the adult reflects the initial attachment of both structures to the calcaneal perichondrium rather than to the skeletal anlagen itself.
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              Basic science and clinical aspects of achilles tendinopathy.

              Achilles tendinopathy is one of the common disorders seen in athletes. It is a degenerative rather than an inflammatory, condition. There is a lifetime risk of 52% in former elite male distance runners. This condition is difficult to manage and up to 29% of Achilles tendinopathy patients may require surgery. It often results in chronic pain and discomfort along with failure to regain full function. It can be complicated by partial tears or complete rupture causing long-term burden on healthcare system and making treatment quite difficult.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ijmorphol
                International Journal of Morphology
                Int. J. Morphol.
                Sociedad Chilena de Anatomía (Temuco )
                0717-9502
                September 2015
                : 33
                : 3
                : 920-929
                Affiliations
                [1 ] Izmir Katip Çelebi University Turkey
                [2 ] Mugla Sitki Koçman University Turkey
                [3 ] Süleyman Demirel University Turkey
                Article
                S0717-95022015000300019
                f8b328a3-93d3-441c-8717-0458105a2396

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Chile

                Self URI (journal page): http://www.scielo.cl/scielo.php?script=sci_serial&pid=0717-9502&lng=en
                Categories
                ANATOMY & MORPHOLOGY

                Anatomy & Physiology
                Fetal development,Morphometry,Calcaneal tendon,Anatomy,Desarrollo fetal,Morfometría,Tendón calcáneo,Anatomía

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