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Insertional Achilles Tendinopathy And Haglund Syndrome
 

Author: Alexandre Lavigne, MD
Affiliation: Kansas City Orthopedic Alliance, University of Missouri PM&R, University of Montreal PM&R
Co Author(s): Michael Khadavi, MD, RMSK
Senior Editor: Derek Stokes, MD

Clinical Vignette: A 54-year-old female runner presented with a two-year history of insidious onset posterior ankle pain that began while running. Over the prior two months, the pain had intensified significantly, ultimately preventing her from continuing to run. On physical examination, there was tenderness over the superior aspect of the posterior calcaneus at the Achilles tendon insertion. She was able to perform single-leg calf raises and single-leg hops, both of which reproduced her symptoms.

Type of Probe Used: 3-14 MHz linear array transducer



Unlabeled Long Axis View of the Achilles Tendon Insertion


Unlabeled Long Axis View of the Achilles Tendon Insertion using color Doppler, demonstrating a few neovessels at the retrocalcaneal bursa and within the deep tendon fibers, consistent with chronic bursitis and tendinopathy.


Labeled Long Axis View of the Achilles Tendon Insertion demonstrating increased thickness, diffuse hypoechogenicity, a Haglund deformity with subcortical cystic changes (solid arrow), and a mild retrocalcaneal bursal effusion (dotted arrow) near Kager's fat pad. Labels: ATPI: Pre-insertional Achilles tendon, ATI: Insertional Achilles tendon C: calcaneus, HD: Haglund's deformity, KFP: Kager's Fat Pad, solid arrow: subcortical cystic changes, dashed arrow: retrocalcaneal bursal effusion.


Unlabeled Short Axis View of the Achilles Tendon Insertion, at the level of the superior edge of the calcaneus.


Labeled Short Axis View of the Achilles Tendon Insertion, at the level of the superior edge of the calcaneus showing increased thickness, hypoechogenicity, and partial tearing of the deep tendon fibers. Labels: AT: Achilles tendon, C: calcaneus, solid arrow: retrocalcaneal bursa, dashed arrow: partial tear.


Unlabeled Short Axis View of the Achilles Tendon Distal Insertion Point, a few millimeters distal to the superior edge of the calcaneus, demonstrating findings similar to those in Figure 4, with the addition of a clearly visible subcortical cyst.


Labeled Short Axis View of the Achilles Tendon Distal Insertion Point, a few millimeters distal to the superior edge of the calcaneus, demonstrating findings similar to those in Figure 4, with the addition of a clearly visible subcortical cyst. Labels: AT: Achilles tendon, C: calcaneus, solid arrow: subcortical cyst, dashed arrow: partial tear.


Unlabeled Short Axis View of the Pre-Insertional Achilles Tendon, a few millimeters proximal to the superior edge of the calcaneus, using color Doppler, demonstrating multiple neovessels within the retrocalcaneal bursa and the deep fibers of the tendon. Notably, the Doppler signal appears more prominent in the short-axis view compared to the long-axis images.


Lateral ankle radiograph confirming the presence of a Haglund deformity (arrow).

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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