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Author Spotlight: Exploring the Complexities of Achilles Tendon Injuries — Research and Future Directions
Published on: October 27, 2023
Achilles Impingement Tendinopathy on Magnetic Resonance Imaging
Mark J Bullock1, Jan Mourelatos2, Alice Mar3
1Surgeon, Saginaw Valley Bone and Joint Center, Saginaw, MI.
Insights
Haglund's syndrome, characterized by Achilles impingement tendinopathy, is often subtle and linked to posterior calcaneal prominence. This condition may be an unrecognized cause of Achilles tendinopathy and potential rupture.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Haglund's syndrome involves retrocalcaneal bursa and Achilles tendon impingement due to calcaneal prominence.
- Traditional radiographic measurements lack sensitivity and specificity for Haglund's deformity.
- Magnetic resonance imaging (MRI) aids diagnosis by localizing bone deformity and tendinopathy.
Purpose of the Study:
- To determine the prevalence of Haglund's syndrome in patients with Achilles tendinopathy.
- To identify associated findings for diagnostic criteria of Haglund's syndrome.
- To evaluate the relationship between calcaneal morphology and Achilles tendinopathy/rupture.
Main Methods:
- Cross-sectional study analyzing 40 MRIs of Achilles tendinopathy and 19 of Achilles tears/ruptures.
- Assessed proximity of tendinopathy to calcaneal tuberosity for impingement.
- Correlated specific calcaneal deformities (posterior prominence, hyperconvexity, loss of recess) with impingement.
Main Results:
- Achilles tendinopathy showed impingement near the calcaneal tuberosity in 67.5% of cases.
- Patients with impingement tendinopathy were more often female and heavier.
- Posterior prominence/hyperconvexity with loss of calcaneal recess was strongly associated with impingement (p < .001).
- 37% of impingement tendinopathies extended to areas prone to Achilles tendon rupture.
Conclusions:
- Haglund's deformity definition should focus on posterior prominence with loss of calcaneal recess, correlating with impingement.
- Achilles impingement tendinopathy may be a more fitting term for Haglund's syndrome due to subtle bone deformity.
- Impingement is a potential, unrecognized cause of Achilles tendinopathy and rupture, challenging the mutual exclusivity of insertional and noninsertional tendinopathies.
Abstract:
Haglund's syndrome is impingement of the retrocalcaneal bursa and Achilles tendon caused by a prominence of the posterosuperior calcaneus. Radiographic measurements are not sensitive or specific for diagnosing Haglund's deformity. Localization of a bone deformity and tendinopathy in the same sagittal section of a magnetic resonance imaging scan can assist with the diagnosis in equivocal cases. The aim of the present cross-sectional study was to determine the prevalence of Haglund's syndrome in patients presenting with Achilles tendinopathy and note any associated findings to determine the criteria for a diagnosis of Haglund's syndrome. We reviewed 40 magnetic resonance imaging scans with Achilles tendinopathy and 19 magnetic resonance imaging scans with Achilles high-grade tears and/or ruptures. Achilles tendinopathy was often in close proximity to the superior aspect of the calcaneal tuberosity, consistent with impingement (67.5%). Patients with Achilles impingement tendinopathy were more often female (p < .04) and were significantly heavier than patients presenting with noninsertional Achilles tendinopathy (p = .014) or Achilles tendon rupture (p = .010). Impingement tendinopathy occurred medially (8 of 20) and centrally (10 of 20) more often than laterally (2 of 20) and was associated with a posterior prominence or hyperconvexity with a loss of calcaneal recess more often than a superior projection (22 of 27 versus 8 of 27; p < .001). Haglund's deformity should be reserved for defining a posterior prominence or hyperconvexity with loss of calcaneal recess because this corresponds with impingement. Achilles impingement tendinopathy might be more appropriate terminology for Haglund's syndrome, because the bone deformity is often subtle. Of the 27 images with Achilles impingement tendinopathy, 10 (37.0%) extended to a location prone to Achilles tendon rupture. Given these findings, insertional and noninsertional Achilles tendinopathy are not mutually exclusive and impingement might be a subtle, unrecognized cause of Achilles tendinopathy and subsequent rupture.
