Diagnosis of Achilles Tendon Pathology: Ultrasonography Versus Plain X-ray

Aims: The current study aimed to highlight diagnostic usefulness of ultrasonography (USG) in Achilles tendon pathology.

Methods: This cross-sectional study was conducted in the department of Physical Medicine and Rehabilitation in co-operation with Orthopedics and Traumatology facility of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study period was 2 years (July 2010 to June 2012); and 61 patients with posterior heel pain selected consecutively. Along with history taking, enrolled subjects examined meticulously. Non-invasive measures such as X-ray, USG (Siemens premium edition, Acuson antares, transducer: VF 10-5, 5.7-10 MHz) also used to acquire further information regarding heel pathology. A semi-structured questionnaire used to preserve primary data. Since, four subjects refused to do USG and X-rays were not available from another seven, we studied over rest fifty. Uni-variate analysis performed. Having been used kappa statistics, sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound and X-ray in several Achilles tendon pathologies performed; p < 0.05 considered statistically significant.

Results: Among of all participants, 38.0% belonged to 36-45 age range and maximum (68.0%) were male. Although a substantial 37 (76.0%) had been suffering from localized back heel pain, 13 (26.0%) of them had systemic diseases like diabetes mellitus (76.9%), dyslipidaemia (1, 2.0%), systemic lupus erythematosus (1, 2.0%), and ankylosing spondylitis (1, 2.0%). Achilles tendinitis, Achilles tendon rupture, retrocalcaneal bursitis, tendon xanthoma diagnosed using ultrasonogram in 31 (62.0%), 7 (14%), 3(6%), and 1 (2.0%) patients respectively. Concerning Achilles tendon pathology, USG was 95.0% sensitive, 50.0%, specific, and 92.0% accurate, whereas diagnostic sensitivity, specificity, and accuracy for X-ray was 39.0%, 75.0%, and 42.0% respectively.

Conclusion: In diagnosing soft tissue pathologies in and around Achilles tendon ultrasound is far better option than conventional X-ray.