Background:Plantar fasciitis is a painful tendinous condition (tendinopathy) with a high prevalence in athletes. While a healthy tendon has limited blood flow, ultrasound has indicated elevated blood flow in tendinopathy, but it is unknown if this is related to a de facto increase in the tendon vasculature. Likewise, an accumulation of glycosaminoglycans (GAGs) is observed in tendinopathy, but its relationship to clinical pain is unknown.Purpose:To explore to what extent vascularization, inflammation, and fat infiltration were present in patients with plantar fasciitis and if they were related to clinical symptoms.Study Design:Descriptive laboratory study.Methods:Biopsy specimens from tendinopathic plantar fascia tissue were obtained per-operatively from both the primary site of tendon pain and tissue swelling (“proximal”) and a region that appeared macroscopically healthy at 1 to 2 cm away from the primary site (“distal”) in 22 patients. Biopsy specimens were examined with immunofluorescence for markers of blood vessels, tissue cell density, fat infiltration, and macrophage level. In addition, pain during the first step in the morning (registered during an earlier study) was correlated with the content of collagen and GAGs in tissue.Results:High vascularization (and cellularity) was present in both the proximal (0.89%) and the distal (0.96%) plantar fascia samples, whereas inconsistent but not significantly different fat infiltration and macrophage levels were observed. The collagen content was similar in the 2 plantar fascia regions, whereas the GAG content was higher in the proximal region (3.2% in proximal and 2.8% in distal; P = .027). The GAG content in the proximal region was positively correlated with the subjective morning pain score in the patients with tendinopathy (n = 17).Conclusion:In patients with plantar fasciitis, marked tissue vascularization was present in both the painful focal region and a neighboring nonsymptomatic area. In contrast, the accumulation of hydrophilic GAGs was greater in the symptomatic region and was positively correlated with increased clinical pain levels in daily life.Clinical Relevance:The accumulation of GAGs in tissue rather than the extent of vascularization appears to be linked with the clinical degree of pain symptoms of the disease.

中文翻译：

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人类足底筋膜肌腱病中广泛的血管化和糖胺聚糖积累与肌腱疼痛的相关性

背景：足底筋膜炎是一种疼痛性肌腱疾病（肌腱病），在运动员中发病率很高。虽然健康肌腱的血流量有限，但超声波显示肌腱病的血流量升高，但尚不清楚这是否与肌腱脉管系统事实上的增加有关。同样，在肌腱病中观察到糖胺聚糖（GAG）的积累，但其与临床疼痛的关系尚不清楚。 目的：探讨足底筋膜炎患者存在何种程度的血管化、炎症和脂肪浸润，以及它们是否与足底筋膜炎相关。研究设计：描述性实验室研究。方法：术前从肌腱疼痛和组织肿胀的原发部位（“近端”）以及在 1 至 1 小时肉眼看来健康的区域获取肌腱病足底筋膜组织的活检标本。 22 名患者距离原发部位（“远端”）2 厘米。使用免疫荧光检查活检标本的血管标记物、组织细胞密度、脂肪浸润和巨噬细胞水平。此外，早上第一步时的疼痛（在早期研究中记录）与组织中胶原蛋白和 GAG 的含量相关。结果：近端 (0.89%) 和远端均存在高血管化（和细胞结构）。远端（0.96％）足底筋膜样本，而观察到不一致但没有显着差异的脂肪浸润和巨噬细胞水平。 2 个足底筋膜区域的胶原蛋白含量相似，而近端区域的 GAG 含量较高（近端区域为 3.2%，远端区域为 2.8%；P = .027）。肌腱病患者（n = 17）近端区域GAG含量与晨间主观疼痛评分呈正相关。结论：足底筋膜炎患者，疼痛局灶区及邻近无症状区域均存在明显的组织血管化。区域。相反，亲水性 GAG 在症状区域的积累较多，并且与日常生活中临床疼痛程度的增加呈正相关。 临床相关性：组织中 GAG 的积累而不是血管化的程度似乎与临床程度相关该疾病的疼痛症状。