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Diagnostic Principles

Acceptable results are most likely to be achieved by correct treatment based upon an accurate diagnosis; this requires a careful history and a thorough clinical examination. With the development of magnetic resonance imaging (MRI), the evaluation of tendon injuries has improved dramatically. This imaging technique not only gives a correct diagnosis, but also permits
assessment of the extent and size of an injury. It provides excellent soft tissue contrast in multiple planes, and permits a detailed assessment of intrinsic abnormalities of ankle joint tendons; it can depict tendinosis, and provides a detailed evaluation of tendon continuation. However, MRI is expensive. Ultrasound is increasingly used (especially in Europe) to evaluate tendon injuries, as it is functional—it can be used during dynamic activities—inexpensive, and can be used to follow the healing process. This technique is valuable, but it depends on a skilled and experienced examiner, and does not show the full extent of the pathological changes.

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