Anatomy of the Achilles Tendon and Examination Technique

Competency 1- Demonstrate appropriate examination techniqueMegan Macdonald- 15758653

AnatomyThe Achilles tendon is formed by the two tendon heads of the

gastrocnemius and soleus muscle. It is considered the strongest tendon within the human body which is located on the posterior aspect of the ankle and is approximately 10-15cm in length (Nunley, 2009).

The tendon is unique in that after the soleous portion the achilles , gastrocnemious and soleal tendon spiral and twist 90 degrees which adds to the strength of the tendon (McNally, 2014).

When in transverse, medial to the Achilles tendon the Plantaris can often be seen. Directly anterior to the achilles is the Kager fat pad. Superior to the distal achilles is the retro- achilles bursa. Inferior to the achilles in close proximity to the calcaneus is the Retro-calcaneal bursa (Jacobson, 2013).

OriginThe Achilles Tendon is situated in the middle

of the posterior calf. It is formed by the gastrocnemious and soleal tendons combined(Nunley, 2009).

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InsertionThe Achilles tendons inserts on the posterior

aspect of the calcaneal tuberosity (Nunley, 2009).

Normal Achilles tendon in Transverse & Longitudinal

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495576/figure/bjr-85-1157-g001/

ActionThe achilles tendon provides the connection

from the muscles to the calceneus allowing plantar flexion of the ankle (Maquirriain, 2011).

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Examination TechniquePatient positioning= Patient supine on the table with foot

hanging of the end of the bed. Dorsiflexion of the foot aids for better visualisation of the tendon.

Equipment= Use lots of gel to allow appropriate contact. High frequency linear transducer. Typically greater than 10MHz.

Technique= Assessing the tendon in both longitudinal and Transverse beginning at the calcaneal insertion to the myotendinous junction.

http://www.essr.org/html/img/pool/ankle.pdf

Ultrasound AppearanceOn Ultrasound the normal achilles tendon

should appear uniform in thickness ,no more than 6mm in the AP dimension (Dong & Fessell, 2009) .

The tendon should consist of a uniform echogenicity with echogenic lines throughout (Bleakney, White, & Maffulli, 2007).

Normal Transverse Achilles Tendon

Bibliography

Nunley, J. A. (2009). The Achilles Tendon: Treatment and Rehabilitation. Ney York: Springer.

 McNally, E. (2014). Practical Musculoskeletal Ultrasound 2nd edn. New York: Churchill Livingstone.

ESSR. (2013). Musculoskeletal Ultrasound Technical Guidelines VI Ankle. Retrieved 2014, from European Society of MusculoSkeletal Radiology: http://www.essr.org/html/img/pool/ankle.pdf

Dong, Q., & Fessell, D. P. (2009). Achilles Tendon Ultrasound Technique. American Journal of Roentgenology Colume 193 No 3 , 173.

ESSR. (2013). Musculoskeletal Ultrasound Technical Guidelines VI Ankle. Retrieved 2014, from European Society of MusculoSkeletal Radiology: http://www.essr.org/html/img/pool/ankle.pdf

McNally, E. (2014). Practical Musculoskeletal Ultrasound 2nd edn. New York: Churchill Livingstone.

 Bleakney, R. R., White, L. M., & Maffulli, N. (2007). Imaging of the Achilles Tendon. Springer.

Jacobson, J. A. (2013). Findamentals of Musculoskeletal Ultrasound. Philadelphia: Elsevier Saunders.

Maquirriain, J. (2011). Achilles Tendon Rupture: Avoiding Tendon Lengthening during Surgical Repair and Rehabilitation. Yale Journal of Biology and Medicine , 289-300.