Insertional Achilles tendinopathy and calcific enthesopathy

Case contributed by Mohamed Saber

Presentation

Pain over the distal Achilles tendon for 2 months, hard swelling in the area

Patient Data

Age: 30 years
Gender: Male

CT study shows thickened distal end of the Achilles tendon (compared with the right side), with a rounded ossification within.

A bony protrusion from the posterior aspect of the calcaneus at the insertion site of the Achilles tendon consistent with calcaneal enthesophyte.

Incidental anterior talar spur

The red line outlines the ossification within the distal Achilles tendon (note separation from the calcaneus)

The blue line outlines the calcaneal enthesophyte (note continuity with the calcaneus)

The yellow color highlights the difference in Achilles tendon size on both sides

Case Discussion

Here is a case of distal Achilles tendinopathy with calcific enthesopathy. The latter is a special type of Achilles tendon ossification that occurs distally at its insertional segment. Associated calcaneal enthesophyte is also seen in our case which is a bony proliferation that develops at the attachment of a ligament, tendon, or articular capsule onto the bone

This patient was subjected to surgery for removal of the calcaneal enthesophyte that was suspected to be the cause of chronic irritation of the distal Achilles tendon. Postoperative improvement was documented

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