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POSTER PRESENTATION Open Access
The “enthesis organ” concept and its relevance tofoot and ankle pathology: a literature reviewTom Walsh*, Chris Bishop
From Australasian Podiatry Council Conference 2011Melbourne, Australia. 26-29 April 2011
BackgroundAn “enthesis’ is described as a junction between ten-don, ligament or joint capsule and bone. Tendinousentheses are a complex and a particularly importantentity, as they are responsible for ensuring contractileforce generated by muscle is transmitted to the skele-ton. While complaints of pain at entheses sites arecommon, rupture or avulsion of tendinous tissue isnot. This review aims to provide insight into whatmechanisms the musculoskeletal system has developedfor protecting tendinous entheses and what are theeffects when these mechanisms are compromised(enthesopathy).
MethodAn electronic database search was performed in October2010. The search strategy used was enthesis* AND foot*AND (ankle* OR enthesopathy* OR enthesis organ* ORenthesitis). A secondary snowball method was con-ducted targeting reference lists and literature only avail-able in hard copy.
ResultsThe initial electronic database search identified 526 arti-cles. 468 were excluded based on title and abstractalone. Inclusion and exclusion criteria were applied andexcluded a further 26 articles. The snow ball methodretrieved a further 7 articles. 39 articles were includedin the review. The literature identified comprehensiveinvestigations on anatomical, functional and pathophy-siological details of tendinous entheses at varied loca-tions of the foot an ankle. On histological examination,there is extensive interweaving of tendinous tissue withfibrocartilage and bone to form the true enthesis. This
interweaving leaves the attachment incredibly robust.Histological sections also revealed structures adjacent,and in close apposition, to entheses that would appearto reduce tensile, compressive and shear stress appliedduring muscular contraction. The arrangement of thesestructures has been termed the “enthesis organ”. Enthe-sopathy was also found to be closely linked withspondyloarthropathies.
ConclusionPathology of the entheses, enthesopathy, can develop forvarious reasons including post traumatic or rheumatolo-gical. The signs and symptoms of enthesopathy can bevaried and can include formation of enthesophytes withchronic pain to changes in nail structure The reviewdescribes the associated anatomy of entheses, the pro-cess of enthesopathy and its association with spondy-loarthropathies. It will introduce and consolidatepodiatrists’ understanding of enthesopathies and howthey present in the foot and ankle.
Published: 20 May 2011
doi:10.1186/1757-1146-4-S1-P56Cite this article as: Walsh and Bishop: The “enthesis organ” concept andits relevance to foot and ankle pathology: a literature review. Journal ofFoot and Ankle Research 2011 4(Suppl 1):P56.
* Correspondence: [email protected] Department, Repatriation General Hospital, Daws Park, SA, Australia
Walsh and Bishop Journal of Foot and Ankle Research 2011, 4(Suppl 1):P56http://www.jfootankleres.com/content/4/S1/P56
JOURNAL OF FOOTAND ANKLE RESEARCH
© 2011 Walsh and Bishop; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
