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We had a great case this week that was a little more complicated. Patient tripped felt a “pop” medial calf 7 months ago. Away on holiday, drove despite pain, tried to massage it out that night. Next day terribly symptomatic. No immediate medical care. She continued to be symptomatic, her Dr. told her it would improve. She was not instructed to undergo physio. She presented to us with distal Achilles pain 7 months after her initial injury. The distal tendon had quite significant enthesopathy, but also the entire tendon showed a thickened echopoor superficial component.
When I looked at the medial gastroc mtj, the patient mentioned that this was the location where the “pop” was felt 7 months earlier. The FGA was thick and echopoor, this extended all the way to the distal tendon and clearly rotated with that portion of the tendon as it traveled distal.
It was a great case, and I have you to thank for helping me understand this pathological process.My point is that many sonographers don’t know how to assess this area. You, Steve, are helping us to make an accurate diagnosis.
Thanks a million!
Sandy -
Hi Sandy,
That is a great case,
From your excellent description there is no doubt that you have seen an FGA tear which has led to a hyper-granulation response.
Unfortunately the patient will likely have medial calf tightness and apprehension moving forward,
What we have not worked out yet is exactly how to treat this condition.
Lovely work Sandy,
Steve
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I agree about the chronic hyper granulation component following FGA injury. Yet another example of how medicine is complex and that two processes may be occurring simultaneously.
Therefore a complete assessment is essential.
Thanks for your excellence in teaching Steve, and your willingness to share.
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My pleasure Sandy,
I have many examples of this pattern in my historical film library.
I have the cases filed under everything from plantaris tendinosis to plantaris tears,
None of which is correct !
We all live and learn.
Steve.
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