Wk 1, Case 1 - Review

Patient History
72-year-old man patient complaining of pain and swelling in the Achilles area for 9 months.

Findings
SKELETAL/BONES:
Moderate to severe enthesopathy of the distal Achilles tendon, with stress edema of the enthesophyte and dorsal calcaneus and calcaneal tuberosity. Prominent dorsal calcaneal enthesophyte is possibly fractured at its base. Prominent enthesophyte-related osseous erosion at the dorsal calcaneus.

Haglund’s deformity with reactive osteoedema noted.

Low-grade (likely stress related) osteoedema involving the medial malleolus and medial talus. No fracture or focal aggressive osseous abnormality.

ARTICULATIONS:
Unremarkable.

LIGAMENTS:
High ankle ligaments: Intact.

Low ankle ligaments: Intact.

Subtalar/Chopart: Intact.

TENDONS:
Moderate to severe insertional tendinopathy and enthesopathy of the distal Achilles tendon with a developing thin undersurface high footprint delamination insertional partial thickness tear measuring 1.3 centimeters length, 1.0 centimeter width and less than 10 percent depth.

A second, mostly concealed tear at the inferior-most segment or footprint is best seen on series 9 image 8 below the delamination.

Tibialis posterior, flexor digitorum longus, flexor hallucis longus, peroneus longus/brevis and extensor tendons are intact and unremarkable in appearance.

GENERAL:
Sinus tarsi: Unremarkable.
Muscles: No traumatic muscle injury. No volumetric muscle atrophy.

Soft tissue: Retrocalcaneal bursa mildly thickened and edematous. No effusion.

Plantar fascia: Intact.

Neurovascular complex/tarsal tunnel: Unremarkable. No evidence of entrapment neuropathy.

Intra-articular/loose bodies: None.

Impressions
1. Moderate to severe insertional tendinopathy and enthesopathy of the Achilles tendon.
2. Developing undersurface delamination high insertional partial thickness tear of the Achilles tendon.
3. Concealed interstitial delamination tear of the lower-most segment of the achilles.
4. Small Haglund deformity.