Presentation
Pain after landing during sport.
Patient Data
Three views of the ankle have been provided. No fracture or dislocation. No definite soft tissue swelling, although perhaps laterally slight swelling is present. Posteriorly the Achilles tendon is slightly wavy in outline with a loss of its normal hyperdensity suggesting a tendon rupture.
Complete rupture of the Achilles tendon at the myotendinous junction with the gastrocnemius muscle, 4 cm proximal to its calcaneal insertion. The gap measures 2 cm. Stranding noted within Kager's fat pad. Calcaneus is normal in appearance. The Achilles tendon appears normal distal to the tear.
Case Discussion
Although plain x-rays are not the modality of choice to assess for ligamentous injury, as the Achilles tendon is thick and relatively hyperdense compared to surrounding tissues (e.g. Kager's fat pad anteriorly and subcutaneous fat posteriorly) it can be well seen and thus a rupture suspected.
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