LEFT ANKLE & FOOT ULTRASOUND
Clinical History: Pain and swelling over the posterior aspect of the left ankle; evaluation of Achilles tendon and suspected foreign body.
Technique: High-frequency linear transducer (7.5–15 MHz) examination of the left ankle and foot in longitudinal and transverse planes, with focused assessment of the Achilles tendon and its calcaneal insertion. Dynamic and Color Doppler assessment performed as indicated.
Prior Studies: No prior imaging available.
ULTRASOUND IMAGES
Longitudinal ultrasound view demonstrating the Achilles tendon and its fibrillar architecture.
Transverse ultrasound view for assessment of tendon thickness, echotexture and structural integrity.
Targeted ultrasound evaluation of the echogenic foreign body in the distal Achilles tendon region.
ULTRASOUND FINDINGS
Joint & Effusion: No ankle joint effusion detected. Visualized joint spaces appear maintained.
Achilles Tendon: The distal Achilles tendon is thickened and demonstrates heterogeneous hypoechoic echotexture with loss of its normal fibrillar architecture, consistent with Achilles tendinosis. Associated hypoechoic peritendinous soft tissue thickening and inflammatory changes are seen, suggestive of peritendinitis. A focal echogenic foreign body is identified in the region of the distal Achilles tendon near its calcaneal insertion, with surrounding localized inflammatory changes. Tendon continuity is maintained without complete rupture.
Medial Tendon Group: Tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons demonstrate preserved fibrillar pattern. No tenosynovitis.
Lateral Tendon Group: Peroneus longus and brevis tendons appear intact without split tear or tenosynovitis.
Anterior Tendon Group: Tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons appear normal. No tendinopathy or sheath fluid.
Ligaments (Where Visualized): Anterior talofibular, calcaneofibular, and deltoid ligaments appear intact.
Plantar Fascia: Normal thickness and echotexture. No plantar fasciitis or tear.
Soft Tissues: Localized inflammatory changes around the distal Achilles tendon and suspected foreign body. No definite drainable collection.
Vascularity (Color Doppler): Mild increased peritendinous vascularity in the distal Achilles region, suggesting inflammatory hyperemia.
IMPRESSION
1. Distal Achilles tendinosis with associated peritendinitis.
2. Echogenic foreign body in the distal Achilles tendon region near its calcaneal insertion, with surrounding localized inflammatory changes.
3. Achilles tendon continuity is maintained without complete rupture.
4. No definite drainable soft tissue collection.
RECOMMENDATION
Clinical correlation and orthopedic consultation are recommended for assessment of the foreign body and associated Achilles tendon inflammation.
| Patient | ________________ | Age | ________ |
|---|---|---|---|
| Sex | ________ | Referral Dr. | Dr. ____________________ |
Pain and swelling over the posterior aspect of the left ankle; evaluation of Achilles tendon and suspected foreign body.
High-frequency linear transducer (7.5–15 MHz) examination of the left ankle and foot in longitudinal and transverse planes, with focused assessment of the Achilles tendon and its calcaneal insertion. Dynamic and Color Doppler assessment performed as indicated.
Prior Studies: No prior imaging available.
Joint & Effusion: No ankle joint effusion detected. Visualized joint spaces appear maintained.
Achilles Tendon: The distal Achilles tendon is thickened and demonstrates heterogeneous hypoechoic echotexture with loss of its normal fibrillar architecture, consistent with Achilles tendinosis. Associated hypoechoic peritendinous soft tissue thickening and inflammatory changes are seen, suggestive of peritendinitis. A focal echogenic foreign body is identified in the region of the distal Achilles tendon near its calcaneal insertion, with surrounding localized inflammatory changes. Tendon continuity is maintained without complete rupture.
Medial Tendon Group: Tibialis posterior, flexor digitorum longus, and flexor hallucis longus tendons demonstrate preserved fibrillar pattern. No tenosynovitis.
Lateral Tendon Group: Peroneus longus and brevis tendons appear intact without split tear or tenosynovitis.
Anterior Tendon Group: Tibialis anterior, extensor hallucis longus, and extensor digitorum longus tendons appear normal. No tendinopathy or sheath fluid.
Ligaments (Where Visualized): Anterior talofibular, calcaneofibular, and deltoid ligaments appear intact.
Plantar Fascia: Normal thickness and echotexture. No plantar fasciitis or tear.
Soft Tissues: Localized inflammatory changes around the distal Achilles tendon and suspected foreign body. No definite drainable collection.
Vascularity (Color Doppler): Mild increased peritendinous vascularity in the distal Achilles region, suggesting inflammatory hyperemia.
1. Distal Achilles tendinosis with associated peritendinitis.
2. Echogenic foreign body in the distal Achilles tendon region near its calcaneal insertion, with surrounding localized inflammatory changes.
Orthopedic consultation and clinical correlation are advised for the suspected retained foreign body. Consider further imaging if indicated, with MRI safety assessment based on the possible foreign body composition.
Ultrasound has limited evaluation of deep joint structures and complex ligament injuries. Foreign body size, depth, and relationship to tendon fibers should be recorded from the actual examination. All described abnormalities require confirmation on the ultrasound images.
Kindly report any typographical errors and submit for correction within 7 days. This report and accompanying images are not valid for medico-legal purposes.
MBBS MD (Consultant Radiologist)
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