Retrocalcaneal Bursitis

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Retrocalcaneal Bursitis

Authors, Editors, Case Information Author: Gerald Megna, MD Affiliation: Self Regional Healthcare Sports Medicine Co Author(s): Dr. Jacob Ringenberg Senior Editor: William Berrigan, MD Clinical Vignette: 21-year old female with non-traumatic right heel pain for approximately 3 months. Patient with tenderness on calcaneal squeeze and palpation deep to the achilles tendon. Pain worse with passive and active dorsiflexion of the ankle. Type of Probe Used: 15-4 linear probe LAX achilles unlabeled Long axis view of the achilles tendon and retrocalcaneal bursa with doppler. Increased vascularity is seen in the bursa. LAX achilles labeled Long axis view of the achilles tendon and retrocalcaneal bursa. A moderate amount of fluid is seen expanding the retrocalcaneal bursa. The achilles tendon appears normal, with no thickening or tearing. SAX achilles unlabeled Short axis view of the achilles tendon and retrocalcaneal bursa with doppler. Increased vascularity is appreciated in the bursa, indicated by the doppler signal. SAX achilles labeled Short axis view of the achilles tendon and retrocalcaneal bursa. A moderate amount of fluid is seen expanding the retrocalcaneal bursa. Interpretation Image Interpretation: There is a moderate amount of fluid in the retrocalcaneal bursa. The bursal tissue is hypertrophic with hyperemia noted on color doppler. The achilles tendon is intact with normal echotexture. Teaching Pearl: It is important to float the probe (especially in long axis) in order to get the best image quality. A neutral or slightly dorsiflexed ankle can help in maintaining probe contact. Ultrasound of the hindfoot can identify common pathology including retrocalcaneal bursitis, achilles tendinosis, achilles rupture, or posterior ankle impingement. Ultrasound should be used to assist with needle guidance for procedures in order to minimize the risk of adverse events. If injecting lateral to medial, the sural nerve needs to be identified prior to needle placement. Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004 Oct;97(10):472-6. doi: 10.1177/0141076809701004. PMID: 15459257; PMCID: PMC1079614. Turmo-Garuz A, Rodas G, Balius R, Til L, Miguel-Perez M, Pedret C, Del Buono A, Maffulli N. Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle? Musculoskelet Surg. 2014 Aug;98(2):121-6. doi: 10.1007/s12306-013-0305-9. Epub 2013 Nov 13. PMID: 24222527.
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Authors, Editors, Case Information

LAX achilles unlabeled

LAX achilles labeled

SAX achilles unlabeled

SAX achilles labeled

Interpretation

UPCOMING EVENTS

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