The Kager fat pad is a triangle of fat that fills the space in front of the Achilles tendon and above the calcaneus at the back of the ankle. It is bounded by the Achilles tendon behind, flexor hallucis longus in front and the calcaneus below, and part of it slides into the retrocalcaneal bursa during ankle movement.
| Location | Posterior ankle, in front of the Achilles tendon. |
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Cushions the back of the ankle, protects tendon blood vessels and moderates pressure in the retrocalcaneal bursa.
On a lateral ankle X-ray the Kager triangle is normally sharp and dark, and blurring of it suggests Achilles tendon rupture, retrocalcaneal bursitis or fracture. The fat pad is thought to protect blood vessels to the tendon and reduce pressure changes in the bursa. Inflammation or impingement of the fat pad can cause posterior heel pain.
Irritation and swelling of the fat pad, often in dancers and runners, causing posterior ankle pain on plantarflexion.
Loss of the normal dark fat triangle on X-ray, a sign of Achilles rupture, haemorrhage or inflammation behind the ankle.
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