Achilles tendinosis and tear

Case contributed by Dr Maulik S Patel

Presentation

Initially bilateral pain in the Achilles tendon region. Then 10 weeks later, an acute exacerbation in the right Achilles tendon region.

Patient Data

Age: 55 years
Gender: Male

1st study. Pain in both Achilles regions.

X-ray

There is a thickening of soft tissue shadow of distal Achilles tendon on both sides along with the presence of enthesophyte. Kager fat pad is normal bilaterally.

1st study. Pain in both Achilles regions.

Ultrasound

There is a thickening of bilateral distal Achilles tendons with the presence of enthesophytes. There is no tendon tear on either side.

2nd study 10 weeks later - sudden increase in right Achilles region pain

X-ray

X-ray with plantarflexed foot shows loss of normal outline of the distal Achilles tendon. There is an avulsed enthesophyte. Kager fat pad shows areas of loss of normal fat density.

X-ray with dorsiflexed foot shows thinning of the distal Achilles tendon. The avulsed enthesophyte shows increased distance from the calcaneum.

2nd study 10 weeks later - sudden increase in right Achilles region pain

Ultrasound

There is a complete tear of the right Achilles tendon. A gap between the two edges of the torn tendon is 30 mm. A bone flake in the proximally retracted tendon is a part of the avulsed enthesophyte.

Postoperative 1 week x-ray

X-ray

A plaster cast is present. There is an anchor in the calcaneum.

Postoperative 2 months x-ray

X-ray

The repaired Achilles tendon soft tissue shadow shows thickening. Kager fat pad shows irregularity. The anchor is in position in the calcaneum.

Case Discussion

The case shows bilateral Achilles tendinosis and progression to a tear in case of the right tendon.  Right Achilles tendon tear which was repaired, fixed with anchor placement.

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