It is important to rule out which conditions for patients presenting with xanthomas?
Hypercholesteremia, genetic syndromes, and metabolic conditions.
Diffuse bilateral right greater than left lobular fusiform thickening of the distal Achilles tendon measuring 2.5 cm on the right and 2 cm on the left in maximum thickness is most compatible with Achilles tendon xanthomas in this patient with bilateral painless posterior ankle masses.
The overlying skin is intact. No abnormal calcifications. No ankle joint effusion on either side. The osseous structures of the ankles are intact. The bone density is normal.