Musculoskeletal ImagingAchilles tendon
(Achilles, ancient Greek hero, whose mother held him by the heel when she dipped him in the Styx river to make him invulnerable).
1. Anatomy
the tendon that attaches the triceps surae muscle to the tuberosity of the calcaneus. It is covered by a fascia rather than a tendon sheath. Also, see Achilles tendon.
2. Pathology
Chronic tendinitis involving the Achilles tendon leads to thickening or focal enlargement. Involved portions of the tendon are of low signal intensity on MR images. Complete or partial disruption (tears) of the tendon, typically occurring in sedentary persons who attempt strenuous activity, is characterized by discontinuity of some or all of the tendon fibres, regions of increased signal intensity on T2-weighted spin-echo MR images, and blood and oedema within a tendinous gap (Fig.1). Ultrasonography also is helpful in evaluating this injury. Predisposing factors include chronic tendinitis, rheumatoid arthritis, systemic lupus erythematosus and administration of corticosteroid preparations.
Superficial bursitis about the Achilles tendon accompanied by retrocalcaneal bursitis and a soft tissue mass at the site of insertion of the tendon is known as Haglunds syndrome.
Xanthomas may involve this tendon in patients with heterozygous familial hypercholesterolemia.
DR/RB
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Disruption of the Achilles tendon.
a. Sagittal turbo inversion recovery MR image of the ankle demonstrates disruption of the Achilles tendon near its musculotendinous junction. Note the waviness of the Achilles tendon and adjacent haematoma (arrow).
b. Axial proton-density MR image with fat saturation demonstrates the disrupted Achilles tendon and adjacent haematoma (arrow).
(Courtesy of Ben Edwards, MD, Savannah, Georgia)
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Achilles tendon, Fig.1 (a) | | Achilles tendon, Fig.1 (b) | |