 So, whenever you see for tendon tears, what you see here basically is that the tendon commonly tears at this level that is around 2 to 6 centimeters above the insertion. And whenever you see an image like this, instead of a normal nice thick fibrillar echopattern of the tendon, what you see here is in a frozen image that this tendon is abnormally enlarged here, there is a calcific density, then the tendon has thinned out here. You don't know whether it's a partial tear or a full tear, but you definitely know that the tendon tissue has decreased here, which alerts you that there is definitely some amount of tear which is there. So, then what we do is we do a dynamic maneuver, do a flexion, a plantar flexion or plant a doci flexion and then you see that the both tendon fragments are basically separating from each other and the Kegel's fat pad is basically herniating between the tendon segments. So, this is nothing but a dynamic examination showing you a full thickness tear only when you do a doci flexion. So, typically when the tendo achilles completely tears from the attachment at the calcainium which is pretty rare, you can actually see that the tendon retracts higher up and you can see the wavy appearance in the proximal tendon. Also there are sometimes degenerative calcifications at the emphasis and this is the Kegel's fat pad which herniates in the gap where the tear is there. So, what we are supposed to do is measure the gap from the superior border of calcainium, see if any distilled tendon tissue is there so that it's always helpful for the surgeon before doing a surgery. Now, this was a patient with a complete tear and you can see that there is hardly any tendon tissue here and what you can see that with the passive dynamic examination I can see that the tendon proximal has retracted higher up, it is not moving at all and you can hardly see any tendon tissue there. Usually such patients they undergo a surgery but if there are patients who are managed conservatively then in the gap where the tear is there you see a fibrous tissue which is forming and this tissue is pretty weak and even with good amount of healing the patient will again tear this particular tissue over a period of time. So, that's the complete tear with fibrous tissue developed because of conservative management and you as you go higher up you can see the retracted portion of the tendon there that's the retracted portion of the tendon and as you go further higher up you can actually see the fibrotic soleus which is showing fatty degeneration. This was a Achilles tear which was managed conservatively in a diabetic and you can see anapsis which is forming all the way through the tendo Achilles into the soleus muscle where you can see some air pockets. Next we come to tendinopathy, whenever a person comes to you for Achilles pathologies it's either a tear or a tendinosis or a tendinopathy. Every tendinosis is one and the same thing it means there is tendon degeneration leading to weakening and a lot of pain. So what typically happens in tendinopathy is you actually see an area of enlargement of the tendon with maybe a subtle calcification and obviously that particular portion of the tendon shows abnormal echopattern, the fibroler echopattern is lost and you sometimes most of the times you see vascularity on Doppler in that region. So that is the place where the patient will have maximum pain and you'll have to give a diagnosis of tendinosis. So typically tendinosis weakens the tendon, predisposes it for a tear and you can actually see there are two areas of tendinosis and tendo Achilles which is a thick fusiform enlargement at two places and what you see here is oblique tears within the tendon substance. This was an enthesitis where you see hypoechoic area at the enthesis where the tendon inserts and this is typically seen in seronegative arthritis with lot of these enthesophytes. This was another case with the enthesitis with the partial tear. So basically if you have a case of tendinopathy and if you have a case of enthesopathy the way to differentiate is tendinosis or tendinopathy will always happen a little proximal to the insertion whereas enthesopathy will always happen where the tendon inserts on the bone. That's your retrocalculial bursitis, classical but when it's a little complicated and severe you can actually see a thick bursa with a little bit of bony irregularity there and the tendo Achilles which is painful over the bursa and there you can see the vascular retina bursa. So this is very classical of retrocalculial bursitis and it most of the times happens in deformities like the aglents which you can where you can see the bony deformity of the posterior heel the tendo Achilles is hardly moving because of pain and you can see the synovitis in the retrocalculial bursa there. Then Achilles tendon if you see it doesn't have a synovial sheath so it has something called as a paratenon which gives blood supply to the tendon so whenever this paratenon gets inflamed you get a severe pain along the mid calf level along the tendon and you see hypoechoic tissue which is nothing but inflamed paratenon. So with this when you are doing ultrasound for ankle it's predominantly a targeted examination and obviously with dynamic examination you can image ankle tendons and ligaments pretty well.