الفهرس 
ANATOMY OF ACHILLES TENDONOnly 14 pages are availabe for public view
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Abstract
The Achilles tendon is the major plantar flexor of the foot and contributes to the maintenance of the upright position. However, it is the most frequent site of injury in the foot because it’s located superficially. The Achilles tendon injury usually occurs due to overuse and trauma.
Achilles tendon injuries are common and increasing in frequency due to their association with aging and physical activity. Many of Achilles tendon pathologies share common pathways and frequently coexist at the time of patient presentation. The trauma of Achilles tendon can sometimes lead to chronicity due to the delayed diagnosis.
Between various imaging techniques may be used to assess the Achilles tendon, this study specifically demonstrated the role of ultrasonography in identifying different Achilles tendon pathological changes.
Ultrasonography has several advantages over the other imaging modalities in terms of safety, availability, comfort and also its high diagnostic performance. Also, the operating costs are low compared to MRI examination.
The earliest diagnosis can be picked up by high frequency ultrasound examination and grading can further be done by MRI evaluation.
Importantly, ankle ultrasound is performed while patients lie in a comfortable position, without pain or claustrophobia. It can be performed in real time helping in clinical correlation of the site of pain and comparison with the contralateral side.
Ultrasonography allows dynamic evaluation of tendons and muscles. In many instances, the entire length of the tendon can be assessed. The tendon function can be assessed dynamically.
The aim of this study was to evaluate the role of ultrasound as a growing and useful diagnostic tool in the assessment of Achilles tendon pathologies. 17 healthy volunteers and 17 cases with Achilles tendon abnormalities were examined by high resolution ultrasound and the results were compared with MRI examination as the gold standard examination.
This study proved that ultrasound provides a good alternative to other modalities, such as MRI, for diagnosing Achilles tendon disorders with a good diagnostic accuracy. Ultrasound and MRI revealed nearly the same results in the evaluation of tendon abnormalities. Both US and MRI imaging can provide important information about the pathologic state of the Achilles tendon and these imaging findings can provide useful information for patient treatment.
The most important limitation of ultrasonography lie in being operator dependent. Yet, the implementation of standardized protocols during ultrasound examination minimize the pitfalls of being operator dependent. Ultrasound is also limited by its limited field of view and penetration, which potentially can result in incomplete evaluation of bony and joint anatomy.
Ultrasound is an excellent cost-benefit widely available imaging modality that has high spatial resolution making it a helpful tool in diagnosing musculoskeletal ankle disorders mainly when evaluation soft tissue structures and extremely valuable when a focused evaluation is needed for a soft tissue structure or precisely examining the region of symptoms. Ultrasonography with the advent of high-resolution linear array as a dynamic, rapid and inexpensive imaging tool and with high accuracy as magnetic resonance imaging can be used as a first-line diagnostic modality in patients with acute tendons injuries. Ultrasound examination is also valuable in assessing ankle tendons injuries when metallic artifacts would limit imaging with MRI or CT.
Magnetic resonance imaging is a good technique for those cases who cannot be confirmed by ultrasonography and shows the extent of the lesion especially when surgical interference is planned.
The choice between US and MRI in such evaluations is determined by availability, referring physician preference, and the experience of the radiologist because in many settings accuracies can be similar.
Ultrasonography is an accurate and sensitive modality in the evaluation of the Achilles tendon and can be used either as a primary tool of investigation or as a complementary tool with MRI and even in some cases may be used as a final method of diagnosis without the need for the futility of repeating both techniques.
Ultrasound can be used as the initial imaging of choice for the evaluation of symptomatic Achilles tendon disorders. However, tendons which appeared normal by ultrasound could be assessed later using MRI to provide detailed regional evaluation and exclude other etiologies that result in similar clinical manifestations.