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MRI Series – Achilles Tendon

MRI Gallery - Achilles Tendon Injuries - Musculoskeletal Imaging

MRI of the

Achilles Tendon.

MRI of the Achilles tendon enables accurate assessment of not only the tendon itself, however the surrounding structures, such as the paratenon and muscular attachments of the gastrocnemius and soleus (“calf”) muscles.

The Achilles tendon, also known as the tendo Achilles, tendo calcaneus or calcaneal tendon, is the longest tendon of the body, formed by the union of the lower aspect of the calf muscles (gastrocnemius, soleus and the variably present plantaris muscle).

The tendon inserts by way of a broad insertion on the calcaneus (heel bone) of the hindfoot. During development, the Achilles tendon is continuous with the broad flat tendon of the foot known as the plantar fascia.

Achilles tendinosis

As for any tendon, degeneration due to wear and tear may occur, known as tendinosis (incorrectly colloquially referred to as tendinitis).

Achilles tendinosis results in pain during activities such as running and may be seen in combination with degeneration of the plantar fascia (known as plantar fasciosis, commonly known as “plantar fasciitis” or “heel spurs”) and strains of the calf muscles [1].

Most cases of tendinosis resolve with conservative therapy, which consists of exercises, eccentric strengthening, heel inserts and activity modification.

Figure 1A & 1B. MRI of the Achilles tendon demonstrates mild fusiform thickening of the mid tendon, compatible with mild tendinosis.

Partial thickness tears

Figure 2A & 2B. With progressive tendinosis, the Achilles tendon increases in size and partial thickness tears start to develop as focal areas of hyperintensity (bright signal) (arrows).

Intrasubstance split tears

Figure 3A & 3B. The tendon can then further increase in size, with tears coalescing to form large partial thickness intrasubstance split tears (arrows).

Achilles tendon rupture

Figure 4A & 4B. Ultimately, as tendinosis worsens, the tendon is no longer viable and undergoes spontaneous rupture (arrows), with dramatic loss of function and pain, often after a seemingly innocuous event.

References
  1. Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh EC. Magnetic resonance imaging findings of injuries to the calf muscle complex. Skeletal Radiol (10):921-7, 2007
Sports & Musculoskeletal Imaging

radiology referrals

Did you know…

That any referral for a scan is valid to use at Melbourne Radiology Clinic, even if it has been written on a referral form from another Radiology or Medical Imaging provider.

Musculoskeletal & Sports Imaging – Clinical Case Examples.