Scott’s AchillesBlog

Well, after meeting with my foot doctor today, getting an MRI, and getting a call from my doctor to schedule emergency surgery tomorrow, I found out that yesterday my “severe cramp” was actually a complete thickness tear of the Achilles tendon.  Not that it’s anything to be proud of, but I’ve now joined the ranks of Dan Marino, Misty May, and Alex Trebek.

I had a notion that it might be something like that after I thought I pulled my calf last week and then had a little swelling around the Achilles this morning.  The weird thing is that I could still move my foot pretty well.  The telling symptom was that I could flex my calf and nothing would happen on my foot.  The MRI showed that the two pieces of tendon were already an inch apart.  My doctor, also an avid mountain biker, told me without surgery I wouldn’t be mountain biking again.  I know this has been debated in the blogs here, however it didn’t take a lot of convincing, I knew what had to happen.  You just hate being forced to have emergency surgery, but I guess this is no different than breaking your leg, you do what you have to do.

Mostly for my future reference more than anything, here is the verdict:

Diagnostic Report:

Diagnosis:

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EXAM: MR Ankle Lt wo EXAM DATE/TIME: 08/18/11 1834

MRI left ankle/Achilles tendon without contrast

Indication: Pain after injury. Evaluate for Achilles tear.

Technique: Three plane proton density and fat saturated proton density utilizing large field of view imaging to encompass the Achilles musculotendinous junction.

Findings: Beginning at the soleus musculotendinous junction, there is a tear of the Achilles which appears complete and demonstrates a 2 cm fluid filled tendon gap on sagittal images 7 - 10. There is edema and fraying through the proximal musculotendinous junction with muscular edema extending to the superior margin of the scan near the mid to distal tibial diaphyseal level. The distal tendon stump appears frayed with some probable low grade interstitial tearing over an additional 2 - 3 cm seen on sagittal image 9. There is surrounding fluid and probable hematoma. No tear from the calcaneal insertion.

There is some mild fraying and tendinosis of the peroneus tendons as they course by the lateral malleolus, without tear or tenosynovitis. Anterior extensor and medial flexor tendons appear normal. Neurovascular structures in the tarsal tunnel are within normal limits.

There is a 9 mm transverse by 17 mm AP osteochondral lesion of the medial talar dome with some mild subchondral plate flattening and subchondral bone edema but no cystic change or fluid undercutting the bone. The overlying cartilage surfaces demonstrate high-grade fissuring and areas of loss best seen on sagittal sequence 10 image 12 - 13 and coronal sequence eight images 12 - 14. In the adjacent tibial plafond slightly more anteriorly there is a focal chondral fissure with subchondral cystic change seen on coronal image 15 and sagittal image 13. There is a small joint effusion and suspected low grade synovitis. No appreciable loose body within the tibiotalar joint.

The remaining bone signal is normal. Subtalar and visualized midfoot articulations appear normal. Bony alignment is anatomic.

There is a thickened, scarred appearance of the anterior talofibular and calcaneofibular ligaments, without acute tear. Posterior talofibular and tibiofibular syndesmotic ligaments are intact. Minimal scarring of the deltoid ligament. Spring ligament appears intact. Normal fat signal through the tarsal sinus. Plantar fascia incompletely imaged but appears intact.

Impression:

1. Proximal Achilles tendon tear appears complete with a 2 cm tendon gap and frayed edematous proximal musculotendinous junction and distal tendon stump.

2. 17 x 9 mm osteochondral lesion of the posterior medial talar dome without convincing unstable lesion. More focal chondral fissuring and subchondral cystic change in the medial tibial plafond.

3. Mild peroneal tendinosis and fraying without tear or tenosynovitis localized to the segment tracking along the lateral malleolus.

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