Objectives: Ankle tendons may be affected by a variety of pathologic conditions, including trauma and overuse, inflammatory and metabolic disorders, or infections. Ultrasound is a very sensitive means of detecting tendinous pathology because of its spatial resolution and its comparative and dynamic capabilities. Its wide availability makes it the preferred first-line imaging modality in cases of ankle pain. Knowledge of the normal anatomy, the clinical symptoms and the setting may help in different diagnoses.

Aim of study: this study aims to highlight the role of high-resolution Ultrasound Doppler and MRI in assessing posterior ankle tendons lesions.

Patients and methods: Our study is a cross-sectional study, included 34 patients, referred to our radiology department at Benha University Hospital with unilateral painful ankles between 2020 and 2021. The study was accepted by the local ethical committee.

Results: Ultrasound and MRI revealed nearly the same results in the evaluation of tendon abnormalities. Our study included 53 tendinous pathological entities detected by MR (standard reference imaging modality) which classified into; degenerative (17 lesions), inflammatory (25 lesions) and tears (partial: 7 or complete: 4 lesions). Two lesions are missed by Ultrasound.

Conclusion: Ultrasonography is an accurate and sensitive modality in assessing the tendons around the ankle joint and can be used either as a primary tool of investigation or as a complementary tool with MRI and even in some cases may be used as a final method of diagnosis without the need for repeating both techniques.