Achilles Midportion Tendinopathy

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Achilles Midportion Tendinopathy

Authors, Editors, Case Information Author: Joseph Brutzkus, MD Affiliation: University of Illinois at Chicago Co Author(s): Ankur Verma, DO Senior Editor: William Berrigan, MD Clinical Vignette: A 50-year-old male recreational runner presented complaining of right posterior ankle pain for 1 year. There was focal thickening of the Achilles tendon on exam. Type of Probe Used: 15-4 mHz Linear Unlabeled Long Axis View of the Achilles Tendon Midportion Unlabeled Long Axis View of the Achilles Tendon Midportion Labeled Long Axis View of the Achilles Tendon Midportion Labeled Long Axis View of the Achilles Tendon Midportion with loss of normal fibrillar architecture and focal thickening of the Achilles tendon midportion Unlabeled Short Axis View of the Achilles Tendon Midportion Unlabeled Short Axis View of the Achilles Tendon Midportion Labeled Short Axis View of the Achilles Tendon Midportion Labeled Short Axis View of the Achilles Tendon Midportion with hypoechoic areas within the tendon. Interpretation Image Interpretation: Loss of normal fibrillar architecture and focal thickening of the Achilles tendon midportion, with hypoechoic areas within the tendon. Findings are consistent with achilles tendinopathy. Teaching Pearl: Midportion Achilles tendinopathy is usually located approximately 2-5 cm proximal to the calcaneal insertion. Ultrasound should assess focal tendon thickening, hypoechogenicity, loss of fibrillar architecture, and Doppler signal, with side-to-side comparison when helpful. Normal Achilles tendon thickness is often approximately 6 mm in the anterior-posterior dimension, but clinical relevance depends on symptoms and load tolerance. Ultrasound should also screen for partial tearing or paratenon involvement. References: 1. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision - 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1-CPG32. doi:10.2519/jospt.2024.0302 2. Sleeswijk Visser TSO, O’Neill S, Colaris JW, Eygendaal D, de Vos RJ. Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy: a large international cross-sectional study. Scand J Med Sci Sports. 2024;34:e14665. doi:10.1111/sms.14665 3. Pass B, Robinson P, Ha A, Levine B, Yablon CM, Rowbotham E. The Achilles tendon: imaging diagnoses and image-guided interventions-AJR Expert Panel narrative review. AJR Am J Roentgenol. 2022;219(3):355-368. doi:10.2214/AJR.22.27632
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Authors, Editors, Case Information

Unlabeled Long Axis View of the Achilles Tendon Midportion

Labeled Long Axis View of the Achilles Tendon Midportion

Unlabeled Short Axis View of the Achilles Tendon Midportion

Labeled Short Axis View of the Achilles Tendon Midportion

Interpretation

UPCOMING EVENTS

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