Achilles tendon tear

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis certain


Sudden pain and inability to walk after falling of sharp objects along the back of the lower leg.

Patient Data

Age: 15 years
Gender: Male
  • The Achilles tendon shows a near complete tear at the musclo-tendentious junction, about 4.8 cm above its calcaneal insertion with resultant retraction and gaping measuring about 3.2 cm seen occupied by fluid and hemorrhagic signal.

  • The distal part of the superior torn portion appears slightly thickened and swollen with abnormal intra-substance altered signal in all pulse sequences.

  • The tear has high signal intensity on fluid-sensitive sequences.

  • Note the intact plantaris tendon inserted into the medial tuber calcanei.

  • edema at the postero-superior calcaneal tuberosity of bright STIR signal.

  • Mild ankle joint effusion.

Annotated image

black arrow==> torn Achilles tendon & White arrow ==> plantaris tendon

Case Discussion

A 15-year-old patient presented with a typical presentation of sudden onset of pain at the back of the heel (typical tear of the Achilles tendon after falling sharp object over his lower calf). It is typically located at the critical zone, usually approximately 5 cm above its insertion. MRI demonstrates a proximal Achilles tendon tear at the myotendinous junction, however spared plantaris muscle and tendon due to its more anterior insertion on the calcaneum.

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