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Instructional Course Lecture   |    
Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Disorders of the Insertion of the Achilles Tendon and Achilles Tendinitis*†
MARK S. MYERSON, M.D.‡, BALTIMORE, MARYLAND; WILLIAM McGARVEY, M.D.§, HOUSTON, TEXAS
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An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
J Bone Joint Surg Am, 1998 Dec 01;80(12):1814-24
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Extract

Because of its size and unique functional anatomy, the Achilles tendon is susceptible to both acute and chronic injury. This paper addresses some of these injuries, including the various forms of tendinitis as well as the various pain syndromes of the retrocalcaneal space, such as retrocalcaneal bursitis and Haglund deformity.
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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Mark S. Myerson, MD
    Posted on May 28, 2010
    Dr. Myerson responds to Dr. Dhingra
    Mercy Medical Center, Baltimore, Maryland

    In response to the query by Dr. Dhingra on the Achilles tendon and its' bursae (1), Dr. Dhingra is quite correct, and is describing a condition commonly confused with retrocalcaneal bursitis. There is a well recognized pre-adventitial bursa which lies between the Achilles tendon and the skin (as opposed to the retrocalcaneal bursa which lies between the Achilles tendon and the calcaneus). The pre-calcaneal bursa can become inflamed and enlarged, the result of irritation against the heel counter of the shoe, leading to the swelling which he describes. Unlike retrocalcaneal bursitis and the Haglund syndrome which is typically superolateral, the precalcaneal bursitis is directly posterior over the superior aspect of the calcaneus.

    Reference

    1. Myerson MS, McGarvey W. Instructional Course Lectures, the American Academy of Orthopaedic Surgeons - Disorders of the insertion of the Achilles tendon and Achilles tendinitis. J Bone Joint Surg Am. 1998;80:1814-24.

    Anuj Dhingra
    Posted on May 14, 2010
    Posterior Swelling at Tendoachilles
    Royale Multispeciality Hospital, Faridabad, India

    To the Editor:

    I found the article by Myerson et al. (1) very informative but there is one query which I would like to have clarified. In many cases, I have seen patients present with swelling posterior to the tendoachilles which is soft to firm in consistency and there is no tenderness anterior to the tendoachilles (suggesting retrocalcaneal bursitis) and there is no spur formation at the posterosuperior aspect of the heel. As stated by you in retrocalcaneal bursitis, there is swelling medial or lateral to the tendoachilles. I would like to know what to label the swelling I described.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

    Reference

    1. Myerson MS, McGarvey W. Instructional Course Lectures, the American Academy of Orthopaedic Surgeons - Disorders of the insertion of the Achilles tendon and Achilles tendinitis. J Bone Joint Surg Am. 1998;80:1814-24.

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