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Insertional Achilles tendinopathy is an umbrella medical term referring to pain and swelling on the posterior aspect of the calcaneus. High‐resolution ultrasound imaging is commonly used in daily practice to assess the pathological changes of the Achilles tendon, cortical bone of the calcaneus, and soft tissues located inside the retrocalcaneal space to optimize the management of relevant patients. To the best of our knowledge, a standardized ultrasound protocol to evaluate the retrocalcaneal bursal complex is lacking in the pertinent literature. In this sense, our step‐by‐step sonographic approach is intended to be an easy and ready‐to‐use guide for sonographers/physicians in daily practice to assess this anatomical complex in patients with Achilles tendinopathy. Needless to say, the peculiar histological features of this V‐shaped synovial/fibrocartilaginous bursa surrounding the posteroinferior wedge of the Kager's fat pad and the retrocalcaneal space make the examination challenging. [ABSTRACT FROM AUTHOR]

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Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The distal calcaneal wedge of the Kager's fat pad (KFP) has the mechanical role of lubricating the region between the Achilles tendon and calcaneus during ankle movements. The purpose of this study was to determine the reliability of real-time ultrasound (RTUS) in visualizing the motion of the KFP during walking in adults. Recordings obtained using RTUS (13-MHz linear array transducer, IOE 323, MyLab 70, Esoate, Genoa, Italy) of the Achilles enthesis region (N = 52) of 47 participants (ranging from 21-79 years in age) while walking on a motorised treadmill at their preferred speed were analysed by three blinded assessors. Motion of the KFP was rated on a 4-point Likert scale (normal to absent). There was good agreement (κ [95% confidence interval] = 0.646 [0.643-0.649]) among the three examiners, with very good agreement (0.823 [0.818-0.828]) when classifying the motion as normal. There was a poor correlation between the motion of the calcaneal wedge and participants' age (0.23-0.32). RTUS provides an adjunct to routine clinical examination to determine if there is normal motion of the calcaneal wedge during walking. This may be of benefit in patients with posterior heel pain for whom abnormal KFP motion is implicated. [ABSTRACT FROM AUTHOR]

The aim of this study is to present a more extensile osteotomy performed for the treatment of Haglunds disease and the results of 2-year follow-up of these patients.Fifteen feet of 15 patients who underwent open surgery by the same surgeon between 2011 and 2015 were included in the study. In this technique, the Achilles tendon is split into two in the middle and tenotomized at its insertion. Retrocalcaneal bursa and exocytosis is completely excised and tenodesis of the Achilles tendon to its old insertion is performed with the help of two 5 mm suture anchors. All patients were discharged on the postoperative first day. Postoperatively, a short leg plaster cast was applied for six weeks with the ankle in slightly plantar flexed position. For the next six weeks, patients were followed up with an ankle foot orthosis with the ankle in neutral position. At the end of the third month, orthosis treatment was discontinued in all patients. The patients were evaluated with the visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores (FAOS) preoperatively and at 3 months postoperatively. The mean follow-up period was 27.4 months. A statistically significant difference was found between preoperative and postoperative for both VAS and FAOS scores (p [Med-Science 2019; 8(4.000): 923-6]

Purpose: The aim of the study was to map connections within the Kager's fat pad between the structures which limit it. Methods: A retrospective re-review of 200 ankle magnetic resonance imaging (MRI) examination was conducted. Connections within the Kager's fat pad between the superior peroneal retinaculum, the fibulotalocalcaneal ligament, the posterior talocalcaneal ligament, the flexor hallucis longus, the paratenon of the Achilles tendon, the flexor retinaculum and bones were studied and a model of the connections was constructed. Results: The superior peroneal retinaculum was directly connected with the fibulotalocalcaneal ligament in 85.5% of cases, the lateral part of the paratenon in 82.5%, the processus posterior tali in 78.5%, the posterior talofibular ligament in 32%, the flexor retinaculum in 29.5% and the anterior talofibular ligament in 9%. The fibulotalocalcaneal ligament was connected with the paratenon (on the medial side 88.5%, on the lateral side 68.5%), the flexor retinaculum in 70%, the posterior process of the talus in 79%, the osteofibrosus tunnel for the flexor hallucis longus in 53%, the posterior talofibular ligament in 43.5% and the calcaneofibular ligament in 10.5%. The posterior talocalcaneal ligament was connected with the fibulotalocalcaneal ligament in 71%, with the osteofibrosus tunnel for the flexor hallucis longus in 76.5%, with the flexor retinaculum in 70%. The plantaris tendon showed projection to the crural fascia in 34 of % cases. Conclusion: In the Kager's fat pad there are present more connections than previously reported. All the connections unit at the level of the posterior process of the talus. [ABSTRACT FROM AUTHOR]

The goal of the study was to perform a detailed anatomical description of the retrocalcaneal bursa (RB). Its morphological arrangement was studied on 10 fresh and 30 embalmed lower extremities by microdissection and light microscopy. The RB was present constantly and in all the cases contained 1–2 cm long synovial fold, beginning on the upper wall of RB and distally interposed between the anterior surface of the Achilles tendon and the posterior surface of the calcaneal tuberosity. The volume of RB was 1–1.5 ml. The histological analysis confirmed that the inner surface of the superior and posterior wall of RB have been covered by unilayered synovial membrane, projecting into synovial villi of different shapes and sizes. In the ceiling of RB, delicate fascicle of skeletal muscle fibers was discovered, radiating distally into the regularly present synovial fold. The whole bottom of RB has been covered by 200–500 μm layer of fibrous cartilage into which the calcaneal tendon attached. The cartilagineous layer continued anteroproximally to cover the whole bursal surface of the calcaneal tuberosity, where the thickness of the cortical bone was reduced on mere 50 μm. The obtained results can be used in the improvement of the differential diagnostics and therapy of diagnostics and therapy of the retrocalcaneal bursitis as well as of other kinds of achillar enthesopathies and heel pain. [ABSTRACT FROM AUTHOR]