Presentation
Swollen ankle, with pain in the medial aspect. Had undergone Achilles tendon surgery. Referred to rule out a tibialis posterior tear.
Patient Data
Small amount of fluid demonstrated in the anterior recess of the tibiotalar joint.
Small hypoechoic oval structure adjacent to the talonavicular joint - possibly a small synovial cyst.
On interrogating the anterior aspect of the ankle, the extensor tendons displayed normal thickness, course, and echotexture, including tibialis anterior, extensor hallucis longus, and extensor digitorum longus.
On interrogating the medial aspect of the ankle, the flexor tendons displayed normal thickness, course and echotexture, including tibialis posterior, flexor digitorum longus, and flexor hallucis longus.
The deltoid ligament is preserved.
On interrogating the lateral aspect of the ankle, the peroneal tendons displayed normal thickness, course and echotexture.
The lateral ligaments are preserved, including anterior talofibular ligament and calcaneofibular ligament.
On interrogating the posterior aspect of the ankle, the Achilles tendon at its distal portion is substantially thickened, hypoechoic, and contains many echogenic structures, partly consistent with calcifications and partly with bone fragments.
Summary:
Severe insertional Achilles tendinopathy with intrasubstance calcifications and/or bone fragments.
The rest of the tendons appear normal.
Soft tissue edema around the ankle.