Kager's fat pad fills the triangular space in front of the Achilles tendon, behind the flexor hallucis longus and above the calcaneus. It is a mobile cushion that protects blood vessels to the Achilles tendon, and its lower wedge slides into the retrocalcaneal bursa as the foot points down. Blurring of this triangle on X-ray suggests Achilles or retrocalcaneal injury.
| Location | Back of the ankle, in the triangle in front of the Achilles tendon and above the calcaneus (Kager triangle) |
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The fat pad acts as a mobile cushion that protects blood vessels to the Achilles tendon and slides into the retrocalcaneal bursa during plantarflexion, reducing pressure at the tendon insertion.
Posterior ankle impingement from Haglund deformity (prominent superior calcaneal posterosuperior tuberosity), os trigonum, or posterior talar process produces pain at the posterior ankle during plantarflexion. The Kager's fat pad is compressed during plantarflexion and its MRI signal change (oedema) indicates posterior ankle impingement. Arthroscopic posterior ankle surgery decompresses the posterior ankle space including the os trigonum, the Haglund deformity, and the Kager's fat pad impingement through posteromedial and posterolateral portals.
Ballet dancer's posterior ankle impingement in the demi-pointe position compresses the Kager's fat pad between the posterior calcaneus, os trigonum, and Achilles tendon producing posterior ankle pain and fat pad oedema on MRI; arthroscopic posterior ankle decompression removes the os trigonum and reduces the posterior tuberosity to relieve the impingement.
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