title: Acute tear of the fascia cruris at the attachment to the Achilles tendon: a new diagnosis.
abstract: BACKGROUND
  The fascia cruris encloses the posterior structures of the calf and connects to the paratenon and the Achilles tendon. We describe the clinical presentation, ultrasound imaging characteristics and the time to the recovery of tears of the fascia cruris at the attachment to the Achilles tendon.
  
  
  METHODS
  Retrospective review of 11 tears of the fascia cruris in the different legs as separate events in 9 patients (6 male and 3 female, mean age 35.52 years, range 11-48) identified using diagnostic ultrasound, after presenting with Achillodynia.
  
  
  RESULTS
  11 participants presented at a mean of 4.5 weeks (range 0.5-12) after onset of symptoms. The left Achilles was more commonly injured than the right (7 : 4) and the lateral side more than the medial (6 : 4) with one case with medial and lateral presentation. Clinically, there was swelling and tenderness over the medial or lateral border in the mid to upper portion of the Achilles. 7 of the 11 (63.6%) had functional overpronation. Ultrasound appearances of a tear were identified as hypoechoic area extending from the medial or lateral border of the Achilles extending along the anatomical plane of the fascia cruris. Average return to activity was 5.2 weeks (range 1-22). Participants presenting later had longer recovery but all participants returned to full activity (r=0.4).
  
  
  CONCLUSIONS
  This is the first description of the clinical details and sonographic findings of a tear to the fascia cruris at its attachment to the Achilles tendon. This needs to be considered as a cause of Achillodynia in athletes as recognition will affect the management.
authors.affiliation: Centre for Sport and Exercise Science and Medicine (SESAME), University of Brighton, Eastbourne, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Webborn
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.affiliation: Centre for Sports and Exercise Medicine, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, London, UK.
authors.forename: Kasthuri
authors.initials: K
authors.lastname: Sarvananthan
authors.affiliation: BMI London Independent Hospital, London, UK.
authors.forename: Otto
authors.initials: O
authors.lastname: Chan
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries*; D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D002648:Child; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D012189:Retrospective Studies; D000068958:Return to Sport / Q000502:physiology; D012421:Rupture / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D014463:Ultrasonography; D055815:Young Adult
keywords: Achilles; Soft tissue; Sporting injuries; Tendon; Ultrasound