case_images: PMC2631494_01
case_images: T2-weighted image of the patient's left heel. MRI machines measure proton density; density is proportional to how dark a tissue appears on the scan. 'T1' and 'T2' are technical terms describing the time required for proton relaxation. T2 images make adipose tissue, water, and other fluids bright, thus these images are ideal for detecting tissue edema. On the image, note the intact flexor hallucis longus (filled arrowheads) pulled taught. The flexor hallucis longus is responsible for what little plantar flexion the patient had left. The arrows show the retracted and limp proximal end of the Achilles tendon, with the bright area of signal intensity (open arrowhead) representing inflammation and fluid migration between the severed ends.
case_images: 1752-1947-3-1-1.jpg
case_images: PMC2631494_01_1752-1947-3-1-1.jpg
case_images: F1
case_images: A 91-year-old Caucasian male farmer presented at the Mayo Clinic, Rochester, Minnesota for evaluation of the acute complaint, "My feet aren't working." Specifically, he reported difficulty with balance leading to inability to walk, and extensive, painful bilateral ecchymoses of his heels (Figures 1 and 2).
case_images: T1-weighted image of the patient's right heel. T1 images do not amplify the brightness of low-density tissue, and therefore do not risk obscuring pathologic findings in more dense tissues, such as tendon and bone. On the image above, arrows follow the complete rupture of the Achilles tendon. Note how the distal end lays 'floppy' over the superior calcaneus (asterisk). The open arrow-heads note intervening inflammation and soft-tissue edema.
case_images: 1752-1947-3-1-2.jpg
case_images: PMC2631494_01_1752-1947-3-1-2.jpg
case_images: F2
case_images: A 91-year-old Caucasian male farmer presented at the Mayo Clinic, Rochester, Minnesota for evaluation of the acute complaint, "My feet aren't working." Specifically, he reported difficulty with balance leading to inability to walk, and extensive, painful bilateral ecchymoses of his heels (Figures 1 and 2).