Case 5 - “My Achilles Heel”
A 30-something female runner begins to notice a twinge on the back of her ankle and heel during some of her runs. She ignores the feeling for awhile until it becomes more incessant. Ice and rest help a little, but the twinge turns into a pain -- enough to send her to a physician. The physical exam reveals tenderness and swelling along the posterior aspect of the heel extending up into the ankle and lower leg. The physician orders an MRI to confirm the diagnosis and to assess the severity of the problem.
 |
| MRI Ankle, image 1 |
 |
| MRI Ankle, image 2 |
The first MR image is from a sagittal (from the side) series showing the ankle. The Achilles tendon is the dark structure running vertically up and down (yellow oval). The tendon is slightly thickened in the middle. In addition, bright areas around the tendon indicate inflammation and edema (excess fluid). The second MR image from an axial (cross-section) series shows the thickening and inflammation at the back of the heel (yellow oval).
 |
| MRI Ankle, normal Achilles (different patient) |
 |
| MRI Ankle, normal Achilles (different patient) |
The normal appearance of the Achilles tendon can be seen in these images from a different patient. Note the smooth, thin, and regular appearance of the Achilles tendon (white ovals).
The Achilles tendon is the largest tendon in the body. Its large size corresponds to the significant forces it transmits when walking, running, or jumping. It is formed by the combination of three different calf muscles joining to form one common tendon. This tendon attaches to the back of the calcaneus (heel bone). The Achilles tendon helps to plantarflex the foot (point the toes down) and helps to serve as a shock absorber. The Achilles tendon receives only a limited blood supply making it prone to degeneration with overuse and age.
Most cases of Achilles tendinitis (inflammation) or tendinosis (degeneration) can be treated conservatively without surgery. The old standby remedies of rest, ice, compression, and elevation are good for the acute, inflammatory stage. Anti-inflammatory medications and compression calf sleeves may also help symptoms. Stretching and strengthening exercises may be curative (and preventative). Of course, adjusting the number and intensity of training miles is important as well. Surgery is usually only required in severe or refractory cases of tendinitis or when partial or complete tendon rupture occurs.
Dean Thornton, MD
Dean is a Musculoskeletal Radiologist with Radiology Associates of Birmingham and a Clinical Associate Professor of Radiology at UAB. He works with many local orthopedists and sports medicine physicians. He also likes to run.
Inside the Runner uses medical imaging to offer readers a chance to see what is going on inside their bodies when something breaks down. From fractures to tendonitis to muscle injuries, this series explores the imaging studies used to help doctors and other medical professionals treat running injuries.
Previous Articles