Indian Journal of Physical Medicine and Rehabilitation

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VOLUME 31 , ISSUE 3 ( July-September, 2020 ) > List of Articles

Original Article

Correlation between Clinical Outcome Following Ultrasound-guided Steroid Injection in Retrocalcaneal Bursa and Preprocedural MRI Findings in Different Grades of Achilles Tendinitis

Dilip K Khatua, Asoke K Middya

Keywords : Achilles tendinitis, MRI, Retrocalcaneal bursa, Tendinopathy, Ultrasound-guided injection

Citation Information : Khatua DK, Middya AK. Correlation between Clinical Outcome Following Ultrasound-guided Steroid Injection in Retrocalcaneal Bursa and Preprocedural MRI Findings in Different Grades of Achilles Tendinitis. Indian J Phy Med Rehab 2020; 31 (3):53-56.

DOI: 10.5005/jp-journals-10066-0075

License: CC BY-NC 4.0

Published Online: 28-08-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Chronic posterior heel or ankle pain most commonly results from the pathology of the Achilles tendon, its insertion into the calcaneum, or the two associated bursae. Achilles tendinitis or tendinopathy, a very common clinical syndrome, primarily resulting from overuse injuries is often associated with retrocalcaneal bursitis. The purpose of this study was to find out the effect of ultrasound-guided steroid injection at retrocalcaneal bursa in cases of Achilles tendinitis and to correlate its clinical outcome with preprocedural magnetic resonance imaging (MRI) grading. Sixty-nine patients with clinically and MRI proven Achilles tendinitis were included in the study. MRI findings of tendinitis were graded according to severity. Each patient received an ultrasound-guided injection of 40 mg of methylprednisolone and 1–2 mL of 0.25% bupivacaine into the retrocalcaneal bursa. The outcome was determined and was evaluated in relation to the preprocedural MRI findings. Fifty-seven patients reported at least some relief of symptoms after a follow-up period of 6 months while 12 patients showed no improvement. Shorter duration of symptoms and minor grade MRI findings were associated with complete resolution. Ultrasound-guided steroid injection in retrocalcaneal bursa may be of benefit in the short-term management of clinically and MRI proven Achilles tendinitis.

  1. Foye PM. Retrocalcaneal Bursitis. - overview. Chief Editor: Sherwin SW Ho. Updated: Sep 12, 2019.
  2. McGee DJ. Lower leg, ankle, and foot. Orthopedic Physical Assessment. 2nd ed., Philadelphia, Pa: WB Saunders Co.; 1992. pp. 448–515.
  3. Snider RD, ed. Foot and ankle. Essentials of Musculoskeletal Care. 2nd ed., Rosemont, ll: American Academy of Orthopedic Surgeons; 1997. pp. 366–489.
  4. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996. pp. 783–812.
  5. Brinker MR, Miller MD. The adult foot. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co.; 1999. pp. 342–363.
  6. Teebagy AK. Leg and ankle. In: Steinberg GG, Akins CM, Baran DT, ed. Orthopaedics in Primary Care. 3rd ed., Baltimore, MD: Lippincott Williams & Wilkins; 1999. pp. 241–247.
  7. Li HY, Hua YH. Achilles tendinopathy: Current concepts about the basic science and clinical treatments. Biomed Res Int 2016;2016:6492597. DOI: 10.1155/2016/6492597.
  8. Alfredson H, Spang C. Clinical presentation and surgical management of chronic Achilles tendon disorders - A retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon. Foot Ankle Surg 2018;24(6):490–494. DOI: 10.1016/j.fas.2017.05.011.
  9. James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med 1978;6(2):40–50. DOI: 10.1177/036354657800600202.
  10. Maffulli N, Binfield PM, King JB. Tendon problems in athletic individuals. J Bone Joint Surg Am 1998;80(1):142–144. DOI: 10.2106/00004623-199801000-00022.
  11. Rovere GD, Webb LX, Gristina AG, et al. Musculoskeletal injuries in theatrical dance students. Am J Sports Med 1983;11(4):195–198. DOI: 10.1177/036354658301100402.
  12. Teitz CC, Garrett WE Jr, Miniaci A, et al. Tendon problems in athletic individuals. Review Instr Course Lect 1997;46(1):569–582. DOI: 10.2106/00004623-199701000-00016.
  13. Winge S, Jørgensen U, Lassen, et al. Epidemiology of injuries in Danish championship tennis. Int J Sports Med 1989;10(05):368–371. DOI: 10.1055/s-2007-1024930.
  14. Aström M. Partial rupture in chronic Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand 1998;69(4):404–407. DOI: 10.3109/17453679808999056.
  15. Wilson JJ, Best TM. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician 2005;72:811–818.
  16. Maffulli N, Kenward MG, Testa V, et al. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med 2003;13(1):11–15. DOI: 10.1097/00042752-200301000-00003.
  17. Pierre-Jerome C, Moncayo V, Terk MR. MRI of the Achilles tendon: a comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies. Acta Radiol 2010;51(4):438–454. DOI: 10.3109/02841851003627809.
  18. Schweitzer ME, Karasick D. MR imaging of disorders of the Achilles tendon. Am J Roentgenol 2000;175(3):613–625. DOI: 10.2214/ajr.175.3.1750613.
  19. Srivastava P, Aggarwal A. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study. Rheumatol Int 2016;36(6):875–880. DOI: 10.1007/s00296-016-3440-4.
  20. Chu NK, Lew HL, Chen CP. Ultrasound-guided injection treatment of retrocalcaneal bursitis. Am J Phys Med Rehabil 2012;91(7):635–637. DOI: 10.1097/PHM.0b013e31825a15d5.
  21. Fredberg U, Bolvig L. Jumper's knee. Review of the literature. Scand J Med Sci Sports 1999;9(2):66–73. DOI: 10.1111/j.1600-0838.1999.tb00211.x.
  22. Goldberg-Stein S, Berko N, Thornhill B, et al. Fluoroscopically guided retrocalcaneal bursa steroid injection: description of the technique and pilot study of short-term patient outcomes. Skeletal Radiol 2016;45(8):1107–1112. DOI: 10.1007/s00256-016-2368-9.
  23. Hoksrud A, Ohberg L, Alfredson H, et al. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial. Am J Sports Med 2006;34(11):1738–1746. DOI: 10.1177/0363546506289168.
  24. Maxwell NJ, Ryan MB, Taunton JE, et al. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. AJR Am J Roentgenol 2007;189(4):W215–W220. DOI: 10.2214/AJR.06.1158.
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