Sonoanatomy of the Achilles tendon insertion in children.
OBJECTIVE
The aim of this study was to describe typical age-related sonographic features of the Achilles tendon and calcaneal apophysis in children, providing a reference for the assessment of heel pathologies during the growth period.


METHODS
The calcaneal apophysis and Achilles tendon insertion of 100 children 2 months to 18 years old were examined by high-frequency gray-scale and color Doppler sonography along both the longitudinal and transverse planes. The thicknesses of the apophyseal cartilage at the calcaneal tuberosity and of the Achilles tendon were measured. Also, the sonographic appearance of the bone-cartilage interface was studied.


RESULTS
In children 2 months to 3 years old, the cartilage of the calcaneal tuberosity apophysis was anechoic, with small scattered echoes. In 19 of these 25 children (76%), the echogenic areas contained at least 1 small vessel, visualized on color Doppler sonography. In 15 of 25 children (60%) 4-6 years old, a wavy interface was noted at the junction of the calcaneus and the apophyseal cartilage.


CONCLUSIONS
High-frequency sonography can yield reliable information about the bone-cartilage interface and the Achilles tendon insertion site at the calcaneal tuberosity in children. The sonographic features of the normal heel described here may contribute to improved assessment of pathologies in this anatomic region.
Grechenig
Wolfgang
W
Department of Traumatology, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria.
Mayr
Johannes M
JM
Peicha
Gernot
G
Hammerl
Randolf
R
Schatz
Bernd
B
Grechenig
Stefan
S
D000125:Achilles Tendon / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D000293:Adolescent; D002111:Calcaneus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018615:Ultrasonography, Doppler, Color