Muscles can be attached to bone by flat tendons called aponeuroses. The abdomen, palms, and soles have well-known aponeuroses. Dupuytren’s contracture affects the hand’s palmar aponeurosis, while plantar fasciitis affects the foot’s plantar aponeurosis. Treatment options include rest, physical therapy, and surgery as a last resort.
The connections of muscles to bone are generally thought of as long, collagenous tendons. Muscles, however, can also be attached by flat, sheet-like tendons called aponeuroses. In essence, the aponeurosis is the membranous expansion of a muscle or muscle group. Under a microscope, it looks similar to a tendon, but has fewer nerves and blood vessels.
There are several aponeuroses in the body, but the best known aponeuroses are found in the abdomen, palms and soles. In the abdomen, the external oblique, which is the largest and most superficial flat abdominal muscle, has its aponeurosis. As the external oblique fibers run toward the midline, they become aponeurotic. The thinnest part of the external aponeurosis called the linea alba is found in the midline by drawing a vertical line along the navel. With pregnancy or abdominal surgery, the external oblique aponeurosis can weaken, which is why abdominal exercises are recommended after these events.
The palmar aponeurosis can be found in the hand. It overlaps the soft tissue and tendons of the flexor muscles. When there is a progressive increase in fibrous tissue of this structure, a condition called Dupuytren’s contracture, or palmar fibromatosis, occurs. The fibrous bands that connect it to the bases of the fingers become shorter and thicker. This leads to marked bending or bending of the fingers, such that the fingers cannot be straightened.
People who have Dupuytren’s contracture are often 40 or older. The fingers most affected are the ring and little fingers, while the thumb and forefinger are usually spared. Progression is usually slow and painless. If it causes significant disability or disability, Dupuytren’s contracture might be addressed with surgery. The procedure, however, is not curative and is fraught with complications, such as injury and infection to the nerves and arteries.
The plantar aponeurosis is located on the sole of the foot. The central part is very thick, but tapers laterally and anteriorly. It is also called plantar fascia, because fascia are dense and evenly distributed connective tissues. The main function of this structure is to support the arches of the foot and to hold the foot structures together. As it goes to the digits, it splits into five bands that cover the digital tendons.
Inflammation of the plantar aponeurosis characterized by pain is called plantar fasciitis. It occurs frequently in athletes due to repeated trauma to the soles of the feet. Foot deformities, obesity, and senile foot fat pad atrophy may also be predisposing factors.
Nonsurgical treatments for plantar fasciitis include rest, cold therapy, physical therapy, stretching, and running shoes for motion control. Pharmacotherapy includes the administration of anti-inflammatory drugs such as corticosteroids, aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs). You can also try orthotics or foot supports. Surgery is a last resort due to the risk of injury and infection to the nerves or arteries.
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