| November 2005 Case of the Month |
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Compiled By: Yung Cho, M.D.
History: 71 year-old woman with posterior ankle pain for one week.
Examination: MRI of the ankle. Sagittal T1 and T2, axial T1, and coronal SPIR.
Findings: Achilles tendon thickening. Linear intermediate signal on T1 and SPIR sequences with 5mm wide, 3mm deep, and 1.7cm long early coalescence of the high signal in the central deep Achilles tendon. Haglund’s deformity is seen. Calcaneal spur with mild plantar fasciitis is also noted.
Diagnosis: Hypertrophic Achilles tendinopathy and tendinitis with a superimposed chronic partial-thickness tear.
Discussion: A hypertrophic tendon suggests chronic disease. Linear abnormal signal within the tendon indicates tendinitis. A partial tear is a focal area of signal abnormality, usually in the deep tendon surface without complete transection.
Predisposing factors to Achilles tendon injury include an increase in frequency/severity of athletic activity, chronic renal failure, gout, rheumatoid arthritis, local/systemic steroid administration, connective tissue disease, and Haglund’s deformity (posterosuperior hypertrophy of the calcaneus seen in high-heel and boot wearers).
Achilles tendon tear is commonly seen in 30-50 year-old male athletes; typically, basketball, tennis, and racquetball players.
Clinical differential diagnosis includes plantaris tendon tear and posterior impingement.
Treatment is surgical repair for tears, either with end-to-end anastomosis or grafts.
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References:
- Pomeranz J, Stephen. Gamuts & Pearls in MRI and Orthopaedics. MRI-EFI Publishing, Cincinnati, OH. 1997. p.252-253.
- Stoller DW, Tirman TJ, Bredella MA. Diagnostic Imaging Orthopaedics. Amirsys Inc. Salt Lake City, UT. 2004
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