![]() ![]() The insertional portion of the tendon is interposed between the retrocalcaneal bursa (anteriorly) and subcutaneous bursa (posteriorly). There are different types of Achilles tendinosis, most commonly hypoxic and mucoid. Injuries are typically posttraumatic in nature with acute tearing superimposed on chronic tendinosis. The Achilles tendon is most commonly injured 2–6 cm proximal to its calcaneal insertion, related to the low vascularity in this portion of the tendon (a.k.a. Posteriorly, you will find the Achilles tendon. The flexor hallucis longus tendon is the second most commonly injured medial tendon, classically seen in dancers. It is important to note that the posterior tibialis tendon can be dysfunctional without evidence of tearing on imaging. Partial-thickness tearing of the posterior tibialis tendon can also appear as thinning or atrophy of the tendon. The spectrum of injuries ranges from tenosynovitis to complete tearing and is commonly associated with flat foot deformity. The posterior tibialis tendon is the most commonly injured tendon along the medial ankle, typically in middle-aged and elderly women. Medially, you will find the posterior tibialis, flexor digitorum, and flexor hallucis tendons (a.k.a. Axial ( a) and sagittal ( b) fat-suppressed T2-weighted MR images of the right ankle demonstrate a full-thickness tear of the anterior tibialis tendon ( arrows) secondary to a recent laceration injury Patients with complete tears have a defect or hypoechogenicity throughout the entire cross-sectional area of the tendon.Īnterior tibialis tendon tear. With partial-thickness tears, you will see a defect or defined hypoechoic region within a portion of the tendon that does not involve the entire cross-sectional area of the tendon. Tendinosis will appear similar to MR imaging with abnormal thickening of the tendon with possible associated regions of intrasubstance hypoechogenicity. On ultrasound, the normal tendon will have a hyperechoic fibrillar appearance. Patients with complete tears have a defect or abnormal increased T2-weighted signal throughout the entire cross-sectional area of the tendon. With partial thickness tears, you will see a defect or fluid-like increased T2-weighted signal region within a portion of the tendon that does not involve the entire cross-sectional area of the tendon. Tendinosis will appear as abnormal thickening of the tendon with possible associated regions of intermediate increased intrasubstance signal. In these cases, you may see associated thickening of the tendon sheath and/or thickened regions of synovium interspersed in the increased T2 signal. In instances where a tendon sheath is present, this abnormal signal is consistent with tenosynovitis or sheath inflammation. Peritendinous inflammatory change appears as increased T2-weighted signal surrounding portions of the tendon. On MR imaging, a normal tendon appears as an ovoid or circular low signal structure with intact margins. Tendinosis sets the stage for tearing, which comes in two variants: partial and complete thickness.Īnkle tendons and any associated pathology can be easily evaluated on imaging, most commonly MR imaging and ultrasound. ![]() This then can progress to tendinosis, which represents progressive degeneration of the tendon fibers with incomplete healing secondary to chronic stress. Tendon pathology occurs along a spectrum, beginning with peritendinous inflammatory change. Tendons have one of the highest tensile strengths of all soft tissues but can get injured secondary to both acute and chronic trauma.
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