Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic achilles tendinosis.

PURPOSE: We conducted a retrospective study of the distribution of sonographically detected abnormalities in the heels of patients who had a clinical diagnosis of Achilles tendinosis.

METHODS

One hundred eighteen symptomatic heels in 73 patients who had a clinical diagnosis of chronic Achilles tendinosis were examined over a 12-month period by the same experienced sonologist. The distribution of altered tendon architecture and features suggesting retrocalcaneal bursitis or Achilles paratendinosis were evaluated.

RESULTS

Sonograms of 118 symptomatic heels demonstrated that 96 (81%) had abnormalities confined to the proximal two thirds of the Achilles tendon, 9 (8%) had abnormalities in the distal third alone, and 13 (11%) had abnormalities at both sites. Of the 109 heels with proximal two-third Achilles tendon disease, 99 (91%) had medial tendon involvement; 22 of the 99 showed diffuse tendon changes. Lateral tendon segment changes were seen in 22 (19%) of the 118 symptomatic heels. No lateral tendon segment was involved in isolation. Of the 22 heels with distal third abnormalities, 14 (64%) had sonographic evidence of Achilles paratendinitis, and 13 (59%) had sonographic evidence of Achilles tendinosis. Eighteen of the 22 had sonographic evidence of retrocalcaneal bursitis. In all cases of distal third tendinosis, the deep surface of the tendon was primarily involved. In the heels with both proximal and distal changes, superficial segment involvement of the mid-Achilles tendon was present.

CONCLUSIONS

Sonography provides information that helps to accurately diagnose clinical Achilles tendinopathy and may help to determine the biomechanical processes involved in the injury.