APONEUROSIS: CHARACTERISTICS, FUNCTIONS, LOCATION - ANATOMY AND PHYSIOLOGY - 2024

The aponeurosis is a fibrous anatomical structure, made up of collagen fibers, which covers the muscles in some areas of the body. Its main function is to unite the muscles to other parts of the body through the grouping of these by means of the tendons.

It should be noted that the aponeurosis can also join its fibers, forming an even more resistant structure. It is of clinical importance when performing a surgical procedure, since it is the structure that supports the postoperative period, especially in abdominal surgeries.

By Dr. Johannes Sobotta - WIKIMEDIA COMMONSFile: Sobo 1909 249.png, Public Domain, There are several points where the aponeurosis is weaker and there may be intra-abdominal tissue protrusion through a hole in it. This injury is known as a hernia.

In abdominal surgeries the aponeurosis is violated, which forms a weak area. The leakage of intra-abdominal contents through a weak area, created by the surgical incision, is known as hernia or surgical hernia.

The aponeurosis located on the soles of the feet can cause pain due to exercise overload in athletes who strain their lower limbs, such as runners.

characteristics

Anatomist90

The aponeurosis is a thin, pearly-white sheet of fibrous tissue. Its connective tissue fibers are mainly collagen and it has great similarity to tendons upon microscopic study.

Function

The main function of the aponeurosis is to join muscle groups with other organs, including bones. There are also areas where two aponeuroses intersect to form a more resistant tissue, as occurs in the abdomen.

Clinical considerations

- Abdominal aponeurosis

The thickness of the aponeurosis is not the same in all areas of the body. It is for this reason that there are weak areas through which deformities called hernias can form.

A hernia is a sac with contents of the abdominal cavity that passes through a weak area of ​​the aponeurosis. Hernias are differentiated depending on their location. The most common are umbilical and inguinal hernias.

After intra-abdominal surgery, the fascia is weakened by the incision. This weakness can lead to the formation of surgical hernias or eventrations.

Diagnosis and treatment

The diagnostic suspicion begins with the symptoms of discomfort, pain and a mass coming out through some point of the abdominal region, especially the groin or the navel, or through a surgical scar.

In general, the patient reports that the mass protrudes when performing some force activity and decreases at rest.

The patients most prone to this type of pathology are those in whom there is increased intra-abdominal pressure. For example, people who must lift heavy loads, chronic coughs or those who suffer from constipation.

The diagnosis of hernias and eventrations is made from the clinical examination, when the doctor notices the leakage of content through the natural weak points of the aponeurosis.

The treatment of these injuries is always surgical, and consists of the repair of the aponeurotic weakness. Sometimes a special mesh must be placed to reinforce the fibrous surface to prevent future relapse.

By Anpol42 - Own work, CC BY-SA 3.0, Hernias and eventrations must be operated on when diagnosed because of the danger of complication.

The most dangerous complications are those in which some part of the intestine is trapped in the hernia without obtaining a blood supply. This condition is known as a strangulated hernia and is a surgical emergency.

- Plantar aponeurosis

In the sole of the foot there is also an aponeurotic structure that covers the muscles and tendons. This structure is attached to the heel from behind and to the toes from the front.

By Rlgdias - Own work, CC BY 3.0, Normally, the plantar aponeurosis allows for normal tendon mobility and gait movements. However, it can have some variations that make the foot painful.

When the aponeurosis is very long, it causes the well-known “flat foot”. There is a decrease in the normal curvature of the foot, which causes pain.

On the contrary, if the aponeurosis is short there is an increase in curvature and the plantar arch tends to be higher than normal.

In both pathologies, the treatment tends to be the placement of shoe inserts made especially by a professional.

By Goodreg3 - Own work, CC BY-SA 4.0,

- Chronic plantar fasciitis or pain

Plantar fasciitis is a very common condition and the leading cause of heel pain. It involves severe pain in the sole of the foot when walking, which can be located from the heel to the middle of the sole.

Typical pain improves with physical activity and worsens with long periods of rest. For this reason, people with this pathology report severe pain upon waking up that improves throughout the day.

Pathophysiology, diagnosis and treatment

Plantar fasciitis is attributed to the excess load on the plantar muscles, either due to poor posture, obesity, lack of elasticity and overexertion in the plantar muscles due to excessive exercise.

The patient presents with pain in the heel or midfoot. Sometimes you have had it for so long that you have taken postures while walking to avoid pain. These postures are known as antalgic, which eventually lead to pain in the knees and back.

By Injurymap - https://www.injurymap.com/free-human-anatomy-illustrations, CC BY 4.0, Treatment is almost always clinical, including the administration of oral analgesics and the injection of corticosteroids directly into the area of ​​pain. The placement of bandages that avoid plantar tension is also common.

Above all, it is important to modify the footwear. Whether with the placement of insoles, heel supports or changing footwear depending on the type of footprint, this part of the treatment is crucial for full recovery.

Plantar fasciitis is a disease that improves slowly with following medical indications. Improvement of the condition is not expected before the first 6 to 8 weeks of treatment.

In patients in whom conservative techniques fail, surgical treatment should be considered. But this is done in few cases of isolated plantar fasciitis.

References

1. Bordoni B, Mahabadi N, Varacallo M. (2019). Anatomy, Fascia. StatPearls Taken from: ncbi.nlm.nih.gov
2. Rivero Fernández, Miguel, & Sanz Moya, Patricia. (2014). Abdominal wall pain. Spanish Journal of Digestive Diseases. Taken from: isciii.es
3. Kingsnorth A. (2006). The management of incisional hernia. Annals of the Royal College of Surgeons of England. Taken from: ncbi.nlm.nih.gov
4. Schwartz, Emily N, and John Su. (2014). Plantar fasciitis: a concise review. The Permanente journal 18.1. Taken from: ncbi.nlm.nih.gov
5. Jenkins, JT, & O'Dwyer, PJ (2008). Inguinal hernias. BMJ. Taken from: ncbi.nlm.nih.gov
6. Lim, AT, How, CH, & Tan, B. (2016). Management of plantar fasciitis in the outpatient setting. Taken from: ncbi.nlm.nih.gov