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The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4\u20135\u00a0cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL\/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 60 patients for each study group were included. Both ratios Ar(FHL\/TS) and Dm(FHL\/TS) showed significant higher values in the tendinopathy group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). There were strong to very strong intraclass correlation coefficients (ICC\u2009=\u20090.75\u20130.93). A diameter ratio Dm (FHL\/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL\/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-021-02891-8","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T05:59:29Z","timestamp":1612850369000},"page":"1387-1393","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case\u2013control study"],"prefix":"10.1007","volume":"31","author":[{"given":"Stephan H.","family":"Wirth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3743-7033","authenticated-orcid":false,"given":"Octavian","family":"Andronic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Aregger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Jungwirth-Weinberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorsten","family":"Jentzsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Hecker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,2,8]]},"reference":[{"issue":"3","key":"2891_CR1","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00264-019-04471-2","volume":"44","author":"JJ Chan","year":"2020","unstructured":"Chan JJ, Chen KK, Sarker S, Hasija R, Huang HH, Guzman JZ et al (2020) Epidemiology of Achilles tendon injuries in collegiate level athletes in the United States. 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