J Korean Foot Ankle Soc.  2016 Sep;20(3):112-115. 10.14193/jkfas.2016.20.3.112.

Characteristics of Achilles Tendon Insertion on Posterior Aspect of the Calcaneus without Pathological Deformity in Adults: A Magnetic Resonance Imaging Study

• Gwak H
• Jung D
• Park H
• Ha D
• Kwak J
• Kim U

• KMID: 2351415
• DOI: http://doi.org/10.14193/jkfas.2016.20.3.112

Abstract

PURPOSE
We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy.
MATERIALS AND METHODS
This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups.
RESULTS
The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group (1.47±0.25 cm) than in the middle insertion group (1.27±0.35 cm). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008).
CONCLUSION
Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

Keyword

Achilles tendon; Calcaneus; Magnetic resonance imaging

MeSH Terms

Achilles Tendon*
Adult*
Ankle Joint
Calcaneus*
Congenital Abnormalities*
Humans
Magnetic Resonance Imaging*
Tendinopathy

Figure

• 

  Figure 1. Posterior aspect of calcaneus (γ), proximal insertion of Achilles tendon (α), distal insertion of Achilles tendon (β) were measured on a midsaggital slice of a T1-weighted ankle magnetic resonance imaging.

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  Figure 2. This scatter plot and linear regression analysis reveals 0.38% proximal migration of distal insertion of Achilles tendon on calcaneus with a year (R2=0.04).

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