Long standing psoriasis: Right heel pain. 17 months into treatment with methotrexate. Ultrasonography shows a persistent power Doppler signal at the interface of Achilles tendon and calcaneus in both long and short axes. There is irregularity of the bony cortex with deposition of echogenic material within the tendon body. A faint anechoic fluid collection is seen deep and superficial to the tendon in the long axis view.
MRI studies in same orientation show edema of the tendon proximal to its insertion. No bone marrow "edema" is seen.
Left: short axis, right: long axis