Value of ultrasonography as a diagnostic tool of the Achilles tendon.

Aim: The goal of this study was to check the usefulness of ultrasonography as a diagnostic tool for a bursitis in the area of the Achilles tendon. Fur thermore, we assessed the shape and size of the retrocalcaneal bursa of nor mal subjects. Method: The ultrasonograms of 28 patients with a bursitis at the Achilles tendon were analysed. In addition, we sonographically examined the region of interest in 10 normal subjects (20 Achilles tendons). We use d a 5 and/or a 7.5 MHz linear transducer. The examination was done in both standard planes. Results: The examination of 10 normal subjects could not r eliably demonstrate a bursa in the expected location of the subachillic bur sa or the subcutaneous calcaneal bursa in a single case. We could, however, depict a subachillic bursitis (echofree to hypoechoic) in 22 patients. A s ubcutaneous calcaneal bursitis was found in 7 cases. Conclusions: The retro calcaneal and subcutaneous calcaneal bursa is not demonstrable by ultrasono graphy in healthy people. Exsudation and proliferation of the bursa, howeve r, facilitate the detection by ultrasound. Taking that into consideration, the sign of the bursitis is not the enlargement but the fact that the bursa is demonstrable at all by ultrasonography. In the case of the peritendinit is of the achilles tendon a concurrent bursitis should be looked for. Durin g operative explorations an existing bursitis has to be removed. Ultrasonog raphy is the method of choice for the diagnostic evaluation of a bursitis i n the area of the achilles tendon.