Competency 1Demonstrate appropriate examination technique
Megan Macdonald- 15758653
Anatomy
 The Achilles tendon is formed by the two tendon heads of the
gastrocnemius and soleus muscle. It is considered the strongest
tendon within the human body which is located on the posterior aspect
of the ankle and is approximately 10-15cm in length (Nunley, 2009).
 The tendon is unique in that after the soleous portion the achilles ,
gastrocnemious and soleal tendon spiral and twist 90 degrees which
adds to the strength of the tendon (McNally, 2014).
 When in transverse, medial to the Achilles tendon the Plantaris can
often be seen. Directly anterior to the achilles is the Kager fat pad.
Superior to the distal achilles is the retro- achilles bursa. Inferior to the
achilles in close proximity to the calcaneus is the Retro-calcaneal bursa
(Jacobson, 2013).
Origin
 The Achilles Tendon is situated in the middle of the
posterior calf. It is formed by the gastrocnemious and
soleal tendons combined(Nunley, 2009).
www.webmd.com
Insertion
 The Achilles tendons inserts on the posterior aspect of
the calcaneal tuberosity (Nunley, 2009).
Normal Achilles tendon in
Transverse & Longitudinal
http://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3495576/figure/bjr-85-1157-g001/
Action
 The achilles tendon provides the connection from the
muscles to the calceneus allowing plantar flexion of
the ankle (Maquirriain, 2011).
http://uvahealth.com/services/childrenshospital/conditions-treatments/203519
Examination Technique
 Patient positioning= Patient supine on the table with foot hanging of
the end of the bed. Dorsiflexion of the foot aids for better visualisation
of the tendon.
 Equipment= Use lots of gel to allow appropriate contact. High
frequency linear transducer. Typically greater than 10MHz.
 Technique= Assessing the tendon in both longitudinal and Transverse
beginning at the calcaneal insertion to the myotendinous junction.
http://www.essr.org/html/img/pool/ankle.p
df
Ultrasound Appearance
 On Ultrasound the normal achilles tendon should
appear uniform in thickness ,no more than 6mm in
the AP dimension (Dong & Fessell, 2009) .
 The tendon should consist of a uniform echogenicity
with echogenic lines throughout (Bleakney, White, &
Maffulli, 2007).
Normal Transverse
Achilles Tendon
Bibliography
 Nunley, J. A. (2009). The Achilles Tendon: Treatment and Rehabilitation. Ney York:
Springer.
 McNally, E. (2014). Practical Musculoskeletal Ultrasound 2nd edn. New York: Churchill
Livingstone.
 ESSR. (2013). Musculoskeletal Ultrasound Technical Guidelines VI Ankle. Retrieved 2014,
from European Society of MusculoSkeletal Radiology:
http://www.essr.org/html/img/pool/ankle.pdf
 Dong, Q., & Fessell, D. P. (2009). Achilles Tendon Ultrasound Technique. American
Journal of Roentgenology Colume 193 No 3 , 173.
 ESSR. (2013). Musculoskeletal Ultrasound Technical Guidelines VI Ankle. Retrieved 2014,
from European Society of MusculoSkeletal Radiology:
http://www.essr.org/html/img/pool/ankle.pdf
 McNally, E. (2014). Practical Musculoskeletal Ultrasound 2nd edn. New York: Churchill
Livingstone.
 Bleakney, R. R., White, L. M., & Maffulli, N. (2007). Imaging of the Achilles Tendon.
Springer.
 Jacobson, J. A. (2013). Findamentals of Musculoskeletal Ultrasound. Philadelphia: Elsevier
Saunders.
 Maquirriain, J. (2011). Achilles Tendon Rupture: Avoiding Tendon Lengthening during
Surgical Repair and Rehabilitation. Yale Journal of Biology and Medicine , 289-300.