Acute tear of the fascia cruris at the attachment to the Achilles tendon: a new diagnosis

Abstract

BackgroundThe fascia cruris encloses the posterior structures of the calf and connects to the paratenon and the Achilles tendon. We describe the clinical presentation, ultrasound imaging characteristics and the time to the recovery of tears of the fascia cruris at the attachment to the Achilles tendon.MethodsRetrospective review of 11 tears of the fascia cruris in the different legs as separate events in 9 patients (6 male and 3 female, mean age 35.52 years, range 11–48) identified using diagnostic ultrasound, after presenting with Achillodynia.Results11 participants presented at a mean of 4.5 weeks (range 0.5–12) after onset of symptoms. The left Achilles was more commonly injured than the right (7 : 4) and the lateral side more than the medial (6 : 4) with one case with medial and lateral presentation. Clinically, there was swelling and tenderness over the medial or lateral border in the mid to upper portion of the Achilles. 7 of the 11 (63.6%) had functional overpronation. Ultrasound appearances of a tear were identified as hypoechoic area extending from the medial or lateral border of the Achilles extending along the anatomical plane of the fascia cruris. Average return to activity was 5.2 weeks (range 1–22). Participants presenting later had longer recovery but all participants returned to full activity (r=0.4).ConclusionsThis is the first description of the clinical details and sonographic findings of a tear to the fascia cruris at its attachment to the Achilles tendon. This needs to be considered as a cause of Achillodynia in athletes as recognition will affect the management.

Tears of the fascia cruris demonstrate characteristic sonographic features: a case series analysis

“…These findings do, however, differ somewhat from other studies on fascia cruris tears 7 . Previous work suggested a lower mean age of presentation (34.8 years) with a range that was skewed towards a younger population (11-48 years), although it is recognised that the numbers in both studies are relatively small.…”

“…Previous work suggested a lower mean age of presentation (34.8 years) with a range that was skewed towards a younger population (11-48 years), although it is recognised that the numbers in both studies are relatively small. It should also be noted that no subject during the four year period, described in this study, was found to have more than one fascia cruris tear, unlike two patients in the Webborn et al (2014) study who each experienced separate bilateral fascia cruris tears 7 . One subject in this study was found to have a medial fascia cruris tear and a separate posterior intratendinous tear within the same tendon (Fig.…”

“…As described above, this study adds numbers to this newly recognised diagnosis 7 . These findings do, however, differ somewhat from other studies on fascia cruris tears 7 .…”

“…It should be noted that despite the tendon appearing tendinopathic on ultrasound with an increased tendon diameter, two subjects reported being asymptomatic for tendinopathy; the remainder presented with symptoms consistent with tendinopathy in addition to the pain from the fascia cruris tear, again strengthening the need to carefully elicit the history and to always consider co-existing pathologies. In the Webborn et al (2014) study only two of the nine patients had ultrasound changes consistent with Achilles tendinopathy 7 . It could be the case, as Frankyln-Miller et al (2009) suggested, that fascial pathology precedes tendinopathy, and thereby fascia cruris tears proceed tendinopathy, although the timelines for the subjects described in this study do not correspond to this theory completely 15 .…”

“…In the Webborn et al (2014) study seven of the eleven tears described were lateral and it was suggested that this was due to tension through the fascia as the foot pronates and supinates 7 . However, due to the essentially equal numbers seen on each side in our data any such mechanism would need to be driven both by supination for lateral tears and pronation for medial.…”