The Achilles tendon and the retrocalcaneal bursa

Abstract

ObjectivesInflammation of the retrocalcaneal bursa (RB) is a common clinical problem, particularly in professional athletes. RB inflammation is often treated with corticosteroid injections however a number of reports suggest an increased risk of Achilles tendon (AT) rupture. The aim of this cadaveric study was to describe the anatomical connections of the RB and to investigate whether it is possible for fluid to move from the RB into AT tissue.MethodsA total of 20 fresh-frozen AT specimens were used. In ten specimens, ink was injected into the RB. The remaining ten specimens were split into two groups to be injected with radiological contrast medium into the RB either with or without ultrasonography guidance (USG).ResultsIn specimens injected with ink, diffusion outside the RB was observed with staining of the anterior portion of the AT. In eight contrast-injected specimens (five USG, three non-USG), a similar localised diffusion pattern was observed, with the contrast identified superiorly and anteriorly. In two contrast-injected specimens (non-USG), the diffusion pattern was more extensive.ConclusionThis study confirmed the existence of connections between the RB and the AT, especially rich in the anteroinferior portion of the tendon, which should be considered a weak zone for substances injected into the RB. We hypothesise that this part of the AT might be most vulnerable to rupture after corticosteroid injections.Cite this article: P. A. Pękala, B. M. Henry, J. R. Pękala, K. Piska, K. A. Tomaszewski. The Achilles tendon and the retrocalcaneal bursa: An anatomical and radiological study. Bone Joint Res 2017;6:446–451. DOI:10.1302/2046-3758.67.BJR-2016-0340.R1.

Autologous Platelet Rich Plasma-A Biological Therapeutic Option for Retrocalcaneal Bursitis and its Associations

“…There is a strong positive correlation and temporal association existing between the occurrence of plantar fasciitis, retrocalcaneal bursitis and achilles tendinopathy [1,6].…”

“…To prospectively review a series of patients who have been treated with biological treatment with autologous platelet rich plasma injections for symptomatic retrocalcaneal bursitis and its associations to determine if PRP injections (1) provide symptomatic relief, (2) improved the visual analogue scale (VAS) score and functional AOFAS scores and…”

“…Retrocalcaneal bursitis is the inflammation of the bursa between the anterior aspect of the Achilles and posterior aspect of the calcaneum which is most commonly seen in professional athletes. Retrocalcaneal bursitis is also associated with achilles tendinitis, plantar fasciitis, calcaneal spurs, fibromyalgia and rheumatoid arthritis [1]. The embryological origin of the plantar fascia seems to be united with the Achilles tendon [2] and this connection comprises a layer of periosteal fibers that declines in thickness and elastic properties with aging [3].…”

Management of acute Achilles tendon ruptures

“…However, the incidence of Achilles tendon rupture has increased over recent years. 1 , 2 Although most Achilles tendon ruptures occur during sporting activities, 3 other factors such as gender, 4 drugs, 5 , 6 intrinsic structural variations, 7 and biomechanical changes related to ageing 2 may all contribute. The process of tendon healing occurs in three distinct phases: inflammation, proliferation, and remodelling.…”