Insertional Achilles calcific spur

Case contributed by Chris O'Donnell

Presentation

Chronic pain and swelling at the Achilles insertion

Patient Data

Age: 30
Gender: Male

Large bony spur at the Achilles insertion with a lucent defect at its junction with the calcaneum

Large bony spur at the Achilles insertion. It is separated from the calcaneum although there is bone marrow edema in the spur and at its articulation with the calcaneum (arrow). Minor tendinopathy in the superficial fibers of the Achilles at the spur insertion (arrow) and cyst formation at the deeper Achilles insertion onto the calcaneum (arrow). No retrocalcaneal bursitis.

Case Discussion

Calcific spurs occur the calcaneal insertion of the Achilles tendon. They are seen in various rheumatic and articular diseases but also in physically active individuals. If symptomatic it is referred to as insertional calcific tendinopathy and may be present with or without calcific deposits in the main body of the tendon. It should be distinquished from Haglund deformity - a bony bump/lump that develops on the postero-superior aspect of the calcaneum away from the Achilles due to pressure from rigid-backed shoes eg basketball sneakers.

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