Achilles Tendonitis - MRI

46 Year old male with pain in the left ankle MRI T2 FS sagittal and T2 FSE axial images showing diffuse hyperintensities in the distal Achilles tendon with mild marrow edema in the calcaneous at the insertion site and mild peritendinous inflammatory changes suggestive of Achilles Tendinitis.

DISCUSSION:

Tendinitis develops insidiously after sudden changes in activity or training level, use of inappropriate footwear, or training on poor running surfaces, especially if high-risk factors are present (Eg, age, cavus feet, tibia vara, heel and forefoot varus deformities).

Achilles tendon injuries may be classified as:

Tendonitis: Overuse of the Achilles tendon can cause inflammation that can lead to pain and swelling.

Tendinosis: Usually, this injury is an asymptomatic, noninflammatory, degenerative disease process (mucoid degeneration). The patient may complain of a sensation of fullness or a nodule in the back of the leg.

A Thompson test is performed to detect rupture of the Achilles tendon. In this test, the patient lies face downward on the examining table with bent knees and the doctor squeezes the back of the lower leg (calf). If the Achilles tendon is at least partially intact, this test causes the foot to flex.

IMAGING TESTS:

Radiographs: May detect soft tissue thickening and fractures if any associated.

Ultrasound may be usefull to detect thickening of the Achilles tendon and peritendinous collection.

MRI of tendonitis show diffuse for T2 hyperintensity within the tendon and inflammatory changes around the tendon with or without peritendinous collection. My show mild enhancement on contrast study.  Focal T2 hyperintensities seen at the tendon insertion suggestive of insertional tendinitis.

MRI helps to differentiate tendonitis from tendinosis and partial/complete tendon rupture. In tendinosis there will be only tendon degenerative changes without inflammatory changes around the tendon.

TREATMENT: Resting the tendon to allow the inflammation to settle down.