Achilles tendon rupture and calcaneal osteitis
History of pain and swelling at posterior aspect of ankle.
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The Achilles tendon shows marked thickening, heterogeneity, fibrillation, with maximum thickening of 10 mm seen at 4 cm above its calcaneal insertion ( watershed zone). This finding is in keeping with chronic tendinosis. Also evident is partial discontinuity (2.5 cm above the calcaneal insertion), with some proximal retraction of the tendon consistent with a high grade partial tear involving approx. 80-90% of fibers. There is fluid in the preachilles bursa and subchondral marrow edema at the cortex of calcaneal Achilles tubercle suggesting reactive osteitis.
Mild edema is noted at anterior talofibular ligament.
MRI ankle study reveals a neartotal Achilles tendon rupture/tear and reactional insertional calcaneal osteitis, probably resultant from chronic Achilles tendinosis with coexistent tendinitis of flexor digitorum longus. Also evident is adjoining soft tissue injury, and minimal interstitial edema at anterior talofibular and tibiocalcaneal ligament.