Prior Achilles repair now with overlying ulceration Ankle/foot: There are surgical changes within the posterior ankle with a cannulated screw present within the posterior calcaneus where the flexor pollicis longus tendon appears to insert. The Achilles demonstrates increased signal intensity and appears thickened and disorganized suggesting tendinosis and/or chronic tearing although the insertion upon the calcaneus appears normal.Within the distal third of the lower extremity posteriorly and within the soleus musculature are multiple high signal intensity tubular structures (series 8 image 9/36, series 15 images 17 and 41 of 60) several of which contain a dot of low signal intensity centrally (series 15 image 33/60). This reaches approximately 13 cm superior to the ankle joint and several of these tubular structures extending to the skin surface. Following gadolinium administration, there is diffuse enhancement of the posterior soft tissues and somewhat rim enhancement of these tubular structures.The forefoot appears normal.Although not tailored for the evaluation of the tendons and ligaments, the extensor tendons appear normal as do the peroneal tendons and the tibialis posterior and flexor digitorum tendons.Tibia/fibula: The proximal/mid tibia and fibula demonstrate normal marrow signal intensity and no evidence of focal fluid collection. There is a mild amount of fatty atrophy of the posterior musculature of the right leg.
1. Multiple tubular structures central dots of low signal intensity centrally within the soleus musculature as detailed above. These findings are suspicious for mycetoma.2. Disorganized appearance of the Achilles tendon suggestive of chronic tearing and tendinosis although the insertion upon the calcaneus is normal.3. Surgical changes of the ankle which appears to involve the flexor pollicis longus tendon or accessory soleus entering an orthopedic screw within the posterior calcaneus.