Remote Fellowship – Foot & Ankle Fundamentals – 11/2/2020
Case 1 – Discussion
Achilles tendinopathy is considered chronic intratendinous degeneration of the tendon which may be complicated by tendon tearing. Achilles tendinopathy is the most prevalent of the ankle tendon tendinopathies, with a higher male predilection, most commonly presenting between 30-50 years of age.
Intrinsic and extrinsic factors are involved in etiology. Intrinsic factors (including tendon hypovascularity and metabolic disorders) and extrinsic factors (such as excessive repetitive micro-trauma or overloading) contribute to tendinopathy, tendon degeneration and micro-tearing. Well-recognized predisposing factors include gout, diabetes mellitus, and systemic inflammatory diseases (e.g., rheumatoid arthritis, peritendinous steroid injection, and quinolone antibiotic therapy such as ciprofloxacin).
MRI signs of Achilles tendinopathy include: increased tendon diameter in the sagittal and axial planes, increased intratendinous signal on T1 weighted images and to a lesser extent T2 weighted images, a thickened paratenon, the presence of peritendinous fluid, and edema of Kager’s triangle.
Characteristics of achilles injuries should include: length, width, depth, high or low footprint, position relative to the superior calcaneus, bursitis, cppd, kager’s space, bundle (medial or lateral), muscular hypertrophy or atrophy, periostitis, and the presence or absence of haglund.
Treatment may require surgical intervention with debridement of adhesions and degenerative tendon, followed by decompression of the tendon.
Moderate-severe insertional Achilles tendinopathy and enthesopathy with a developing undersurface insertional partial tear in a 72-year-old man complaining of pain and swelling in the Achilles area for 9 months.
- Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. American Journal of Roentgenology 2000; 175:613-625