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Predictive Measurement for Windlass Change in Length and Selected Treatment Outcomes in Chronic Plantar Fasciitis
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Vascular and Neural Compression Syndromes Associated with Plantaris Muscle Variants: A Classification-Based Review.

Łukasz Olewnik1,2, Ingrid C Landfald1,2,3, Magdalena Łapot1

  • 1Department of Clinical Anatomy, Mazovian Academy in Płock, 09-402 Płock, Poland.

Journal of Clinical Medicine
|May 4, 2026
PubMed
Summary
This summary is machine-generated.

Variations in the plantaris muscle (PM) can cause popliteal artery entrapment syndromes (PAES) and nerve compression. This study provides a framework to classify PM variants and assess their risk for neurovascular conflict.

Keywords:
Duplex/DopplerMRI band signanatomical variationcommon peroneal nerveplantaris musclepopliteal artery entrapment syndromepopliteal fossarisk stratificationtibial nerve

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Area of Science:

  • Anatomy
  • Vascular Surgery
  • Radiology

Background:

  • The plantaris muscle (PM) exhibits significant variability in its proximal attachments.
  • These variations can alter the popliteal corridor, potentially leading to popliteal artery entrapment syndromes (PAES) and neural compression.
  • Existing anatomical data lacks a unified, classification-linked framework for assessing PM's role in neurovascular compression.

Purpose of the Study:

  • To develop a classification-linked, imaging-integrated framework for proximal plantaris muscle variants.
  • To stratify vascular and neural compression risk based on these variants.
  • To propose an integrated risk matrix and a diagnostic/operative pathway.

Main Methods:

  • A narrative review synthesizing adult and fetal anatomical data with clinical-radiological evidence.
  • Classification based on the Olewnik schema (Types I-VI) and accessory variants.
  • Mapping variant geometry to provoked Doppler ultrasound findings and MRI/MRA correlates (axial "band sign") to derive graded risk.

Main Results:

  • Baseline risk is low for canonical types (I-IA, V), moderate for capsular-junction patterns (II/III), and higher for lateral linkage (Type IV) and multi-headed variants.
  • An integrated risk matrix upgrades risk for specific imaging findings (band sign, Doppler compromise) and multi-headed/Type IV anatomy.
  • An imaging checklist, common pitfalls, and operative checkpoints are provided.

Conclusions:

  • A classification-linked, imaging-integrated approach clarifies the association between proximal PM variants and neurovascular entrapment.
  • This framework can improve diagnostic precision and surgical planning for conditions like PAES.
  • It operationalizes variant naming, standardizes imaging, and prioritizes higher-risk variants for review.