Summary:

In this video, we examine a unique case of Achilles pain that doesn’t stem from typical tendon thickening, but instead from extra bone growth at the heel—right where the Achilles tendon attaches. At first glance, the tendon appears healthy and not thickened, misleading both patients and providers.

However, deeper ultrasound imaging reveals a prominent bony bump, known as insertional Achilles tendinopathy, which is the true source of the patient’s pain and swelling. The affected heel shows irregular bone structure, hypoechoic (dark) areas, and localized inflammation right at the pain point.

The comparison with the other (non-painful) side shows only minor tendon changes, confirming that the extra bone and tendon irregularity at the insertion point is the root cause of discomfort. This video is a great resource for understanding less obvious causes of heel pain and how ultrasound imaging can reveal hidden structural issues often missed in a surface-level exam.

Transcript:

This is Dr. Shaun Lehman, and here is an interesting case with Achilles pain at the attachment of the heel. And here is the tendon right here, and it is not thick.

It looks pretty good, except I am hiding from you what the real issue is. And we’ll go to the next.

And here is some extra bone growth here. And so if you look at the patient’s heel, he has a very big bump at the heel where the Achilles attaches, and you have this extra bone growth.

And here is the other side, and he does have a little dark spot in the tendon, a little micro thickening, but he doesn’t hurt at all here.

And as I go more distally, you’ve got extra bone growth on this side as well and some hypoechoic or dark spots here as well. And this is exactly where he hurts, and that’s where his swelling is, and that is where his issue is with pain.

So in this video it’s kind of sliding left or right showing the irregularity of the bone there and some of the irregularity of the tendon as it attaches. Thank you.