Achilles Tendon Injury
Achilles Tendon Scanning
How to scan:
Have the patient lay prone with the foot facing downwards off the side of the bed. Use the linear transducer in sagittal orientation with the probe marker facing cranially. Scan from the calcaneus to visualize insertion, to the body of the gastrocnemius. Switch to transverse orientation with the probe marker facing the patient’s right and repeat. Scan from insertion at the calcaneus to the body of the gastrocnemius.
Sagittal scanning
Transverse Scanning
Try to identify the structures demonstrated in the below images.
Click here to see labeled images.
Special tests:
Thompson test-
Flex the knee to 90° and squeeze the patient’s calf. An intact Achilles tendon will fully plantarflex the foot when the calf is squeezed. This is a negative Thompson test.
Pathologic Achilles
Sagittal scanning
Transverse Scanning
Try to identify the structures demonstrated in the below images.
Click here to see labeled images.
Special tests:
Thompson test-
Flex the knee to 90° and squeeze the patient’s calf. If the tendon is ruptured, squeezing the calf results in minimal or no foot plantar flexion. This is a positive Thompson test. Sensitivity 96%, specificity 93%.(1)
Visit our case file for more information about the presentation and management of Achilles rupture!
Special thanks to Dr. David Haidar for the provided ultrasound images.
Special thanks to Dr. Thomas Scott for assistance with the provided clinical photos.
References:
Maffulli, Nicola. "The clinical diagnosis of subcutaneous tear of the Achilles tendon." The American journal of sports medicine 26.2 (1998): 266-270.