48 years female with complaints of pain posterior aspect of the foot with no trauma, shows markedly irregular and heterogeneous distal tendoachilles with areas of edema with insertional site enthesitis with enlarged and irregular retrocalcaneal bursa with suggestion of retroachilles bursa with reactive marrow edema – Achilles Tendinopathy with Enthesitis is suggested. Case submitted by Dr MGK Murthy.
Teaching points :
Formed in the mid leg by confluencing of two head of gastrocnemius (lateral joining lower than medial) and soleus.
Is enclosed in paratendon (equivalent of synovium).
Inserted into the calcaneum posterior and lateral to the plantaris insertion.
Plantaris togather with achilles refered to as Triceps-Surae complex.
A horseshoe shaped natural retrocalcaneal bursa is invaribly present, limited anteriorly by Kager's fat pad and posteriorly by the tendon.
An acquired retroachilles bursa posterior to the tendon is pathological.
Mucoid degeneration with interstitial tears along with hypoxic fatty degeneration leading to bulky achilles is common age related finding.
Most commonly injured tendon in the foot either because of trauma or overuse.