ormal, and the patient was referred for diagnostic ultrasound.

Figure 2a. Longitudinal image of the anterior tibial tendon at the level of the ankle joint with the foot plantar flexed. The tendon has alternating hypoechoic stripes perpendicular to the tendon (anisotropy) and an undulating wavy appearance (white arrows). The image was taken at the site of the now healed laceration.

Figure 2b. Moving more proximal along the anterior tibial tendon, the tendon goes from normal thickness (green line) to nearly double the size (white line).

Figure 2c. Above this level of the thickened tendon, there is a focal tendon stump with a ragged edge and edge shadowing (white arrow). While there is a linear hypoechoic fibrillar structure extending to the stump. This is less than 1/4 the thickness of the stump.

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Introduction to Tendons on Ultrasound: A Common Sense Approach

Case 2