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Musculoskeletal » Lower Extremity
Retrocalcaneal bursitis and Achilles tendon tendinosis
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Author(s) :
Taco Geertsma, MD
 
Presentation 30 year old athlete with persistent heel pain on the right side
 
 
 
Caption: Longitudinal image of the right distal Achilles tendon
Description: There is a fluid filled thick walled bursa dorsal of the achilles tendon
 
 
 
Caption: Transverse image of the right distal Achilles tendon
Description: There is a fluid filled thick walled bursa dorsal of the achilles tendon with rounded contours
 
 
 
Caption: Longitudinal image of the right distal Achilles tendon
Description: The AP diameter of the achilles tendon is 6 mm.
 
 
 
Caption: Longitudinal image of the contralateral (left) distal Achilles tendon
Description: The AP diameter of the normal left achilles tendon is 4,9 mm. There is no fluid filled bursa
 
 
 
Caption: Longitudinal color doppler image of the right distal Achilles tendon
Description: There is marked hypervascularity in the tendon and bursa wall
 
 
 
Caption: Transverse color doppler image of the right distal Achilles tendon
Description: There is marked hypervascularity in the tendon and bursa wall
 
Final Diagnosis Retrocalcaneal bursitis and Achilles tendon tendinosis
 
Discussion

There is a thick walled fluid filled bursa between the Achilles tendon and the calcaneal bone. The color Doppler images show hypervascularity of the bursal wall.

A minimal amount of fluid in the retrocalcaneal bursa can often be found.

A retrocalcaneal bursitis is caused by friction of the Achilles tendon over the upper part of the calcaneal bone. It is often an overuse injury found in athletes. 

Signs indicating a bursitis are

  • A rounded contour
  • A thick wall
  • Hypervascularity
  • Increased echogenicity of Kagers fat

A retrocalcaneal bursitis is often found in combination with a tendinosis or tendinopathy of the distal Achilles tendon. Common signs of an Achilles tendinosis or tendinopathy are

  • Swelling of the tendon
  • Inhomogenous hypoechoic aspect
  • Loss of the normal fibrillar pattern
  • Hypervascularity or neovascularity

In this case there is only slight swelling of the tendon and the normal fibrillar pattern is preserved. There is however a marked hypervascularity.

For more cases of retrocalcaneal bursitis or Achilles tendon pathology visit www.ultrasoundcases.info

 
Case References

Schepsis AA, Jones H, Haas AL.Achilles tendon disorders in athletes. Am J Sports Med. 2002 Mar-Apr;30(2):287-305.

 

 
Follow Up

Treatment of a retrocalcaneal bursitis is usually conservative with cessation of the sports activities. An ultrasound guided puncture of the bursa and injection of a combination of a corticosteroid and an analgesic can quickly relieve the patient pain

 

 

 
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