This is Barry Belosis, one of the musculoskeletal radiology fellows at Stanford University. 30 year old male with bilateral posterior ankle pain, concerned for Achilles tendinopathy. When evaluating Achilles tendon on ultrasound, we look and evaluate at its thickness, its contour, its echogenicity, and the surroundings of tissue, including the Cagre's fat pad and the paratenon region. The patient in this case presented with this ultrasound. The upper images demonstrate the right Achilles tendon, which shows mild thickening and hypoechoic region in the central portion of the mid-substance of the Achilles tendon, and with associated rounding of the anterior margin here, and also seen under transverse imaging. There is also associated echogenicity of the adjacent Cagre's fat pad. On the left-hand side, we can see here the left Achilles tendon demonstrating thickening, mild hypoechoic centrally, and rounding of the anterior contour, also seen here under transverse imaging. And here we can also see the echogenic or bright Cagre's fat pad. Color adopter is also used in evaluation of Achilles tendon. In the setting of Achilles tendinopathy, color flow as seen here on the anterior margin of the Achilles tendon in the sagittal color adopter images and transverse images suggest neovascularization, although increased flow can also be seen in the setting of inflammation in granulation tissue, but normal Achilles tendon does not demonstrate any vascularity.

2nd Edition, CASE 11

2nd Edition

Foot and Ankle

Achilles tendinopathy

ultrasound evaluation

neovascularization

musculoskeletal radiology

Stanford