A thin-walled bursa within the paratenon of the Achilles tendon, forming between the tendon and its surrounding paratenon sheath in the mid-portion region. It is distinct from the retrocalcaneal bursa and is associated with mid-portion Achilles paratendinopathy rather than insertional disease.
Achilles paratenon bursitis presents as diffuse Achilles thickening and tenderness in the mid-portion, 2-6 cm above the calcaneus. It is part of the paratendinopathy spectrum and is distinguished from intratendinous degeneration by MRI showing fluid in the paratenon rather than intratendinous signal change. Eccentric loading exercises and topical GTN are first-line. Paratenon stripping is rarely required.
Inflammation of the Achilles paratenon bursa and surrounding tissue producing diffuse mid-portion Achilles swelling and crepitus during movement, distinguished from insertional disease by its location 2-6 cm proximal to the calcaneus.
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