Distal Plantaris Tendon Rupture in Professional Football Players: Two Case Reports of a Rare Injury.

Abstract

Context: Distal plantaris tendon rupture is an exceptionally rare injury, often misdiagnosed as Achilles tendinopathy or partial Achilles rupture due to overlapping symptoms and anatomical proximity. While the plantaris muscle contributes minimally to plantarflexion force, its proprioceptive function may be relevant in high-performance athletes.

Case presentation: We present 2 cases of distal plantaris tendon rupture in professional football players, including one athlete with bilateral rupture on separate occasions. Both sustained acute posterior ankle pain during eccentric dorsiflexion and heel-rise test without a palpable defect. High-resolution ultrasound confirmed isolated plantaris tendon rupture, allowing for timely diagnosis and management.

Management and outcomes: Both athletes underwent conservative rehabilitation, emphasizing progressive loading, proprioception training, and sport-specific reintegration. They returned to full competition within 4 weeks without complications.

Conclusions: Distal plantaris tendon rupture, though rare, should be considered in differential diagnoses of acute Achilles pain. Ultrasound is a valuable diagnostic tool, and structured rehabilitation ensures rapid recovery. The bilateral rupture in one athlete raises concerns about intrinsic risk factors, warranting further research into biomechanical and anatomical predispositions in elite sports.