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Achilles paratenonitis

Case contributed by Roberto Schubert
Diagnosis certain

Presentation

Heel pain for several weeks. No history of trauma.

Patient Data

Age: 45 years
Gender: Female
mri

Diffuse edema around the Achilles tendon, especially along the posterior surface and in the fat tissue in Kager's triangle.

Small fluid collection in the retrocalcaneal (subtendinous) bursa.

The Achilles tendon itself is not thickened and shows only minor signs of tendinosis.

Case Discussion

The Achilles tendon does not possess a synovial sheath 1. It is surrounded by a loose areolar tissue, called the paratenon. The paratenon is typically found in straight tendons with a high proportion of elastic fibers. It permits free movement of the tendon against the surrounding tissues. Together, the epitenon and the paratenon compose the peritendon. Hence, the term peritendonitis could be applied as well.

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