MRI results

[sbrewer]

Hi,
I had an MRI done of my heel/achilles area, and would like to know what it means as far as treatment and so forth...does it sound bad?

Finding: The distal 5.0cm of the Achilles tendon is abnormally thickened with intrasubstance signal consistent with tendinosis. 1.0cm proximal to the insertion, there is a linear intrasubstance tear extending superiorly to inferiorly 14mm. This is seen at the anterior edge of the tendon. There in no full thickness tear. There is a large amount of retrocalcaneal bursal fluid. There is high signal in the peroneal brevis tendon at the level of thefibula consistent with intrasubstance tear. There is an inferior calcaneal spur. Everything else is good and intact.

Impression: Tendinosis of the Achilles tendon with intrasubstance tear and retrocalcaneal bursa fluid. Intrasubstance tear peroneal brevis.

Thanks,
sbrewer

[Dr. D]

The findings on your MRI are common for Achilles tendinosis. Tendinosis is represented as the abnormal thickening of the tendon, which is consistent with tendon deterioration. Tendonitis, is inflammation. This means that the collagen fibers which make up the tendon become disorganized and infiltrated with small blood vessels. The result is a weak tendon. The infracalcaneal spur is not associated with the Achilles tendon. The peroneal brevis is the tendon on the outside of the leg which helps to stabilize the foot. The high signal intrasubstance tear could be a peroneal tendon tear or tendonitis. Usually pain at the peroneal tendons is due to an overuse injury or acute tear, but also can be a secondary problem as a result of ankle instability. It is hard to give you specific answers without a history or an evaluation - but hopefully this information helps.

[sbrewer]

Thanks Dr. D for your response. I went back to my dr., and at that time I was wearing Crocs, he told me not to wear Crocs and go back to wearing sneakers. I just started wearing Crocs a couple a months ago and wore sneakers all the time before that. I had this problem in '05 and one Podiatrist said it was haglund's deformity without x-rays or anything, the next Podiatrist said it was the achilles tearing away from the heel bone, he took x-rays. Anyway, I wore the Cam Walker for six months and it got better, but looks like its back again. I guess it's the same thing because it feels the same.
Thanks,
sbrewer

[sbrewer]

Hi,
Is there a reason that this condition would keep returning? Also, is a 14mm tear considered a small tear?
Thanks,
sbrewer

[Dr. D]

It's difficult to say why the Achilles tendonitis/tendinosis continues to reoccur without evaluating your foot, but based on your history it seems likely it is due to a combination of the types of shoes your are wearing and your foot type. Do you have a high arch foot or a low arch foot? If you've been told you have a Haglund's deformity in the past and you are experiencing peroneal brevis tendon problems, then my guess is that you have more of a high arch foot. Or, you have a high arch foot with sitting which is very flexible and collapses with standing. Both foot types are prone to Achilles problems.

Another common issue with chronic Achilles tendonitis/tendinosis is a tight calf muscle. When the calf muscle is tight, it causes excess stress on the Achilles tendon. The heel comes up early when walking, placing excess stress on the arch and the tendons on the inside of the foot (posterior tibial tendon) and outside of the foot (peroneal tendon). This tends to be an underlying cause for many common foot problems.

Calf stretching, heel lifts and supportive shoes are the keys to prevention. Crocs are very flexible shoes which offer no support and contribute to many foot problems.

A Haglund's deformity is a bony prominence on the back of the heel which is due to a certain foot type (generally a high arch) in combination with excess rubbing on the heel counter of the shoe. A retrocalcaneal spur, is spurring which develops on the back of the heel in response to excess stress and traction from the Achilles tendon, and can be associated with insertional Achilles tendonitis.

Lastly, a 14 mm longitudinal intrasubstance tear is not very long and it's hard to know exactly what this finding on the MRI actually represents.

[sbrewer]

Thanks Dr. D,
I probably do have a high arch. I'm not sure how to tell if you have a high arch or not. However, I did remember one thing that I have not posted to you yet...I was told by the same Podiatrist that told me I had Haglund's, that I was very supinated especially on the left foot, which is where my trouble is. At that time, I did not know what that was, but now I know and boy oh boy, do I ever walk on the outside of my feet. I started just about 3 or 4 months ago wearing the Crocs(which I loved, but had to quit wearing), anyway, when you look at the bottom of those shoes, the left one especially is worn on the outside. My dad walked the exact way that I do now.
Again Thanks for your help,
sbrewer