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This study investigated the association between accessory soleus muscle and abnormalities of the Achilles tendon.The authors reviewed 15 consecutive cases with a diagnosis of accessory soleus muscle from a computerized database of ankle magnetic resonance (MR) examinations reported between January 1998 and January 2007. On review, two cases were eliminated because of an incorrect initial diagnosis: One patient had a low lying soleus attachment to the Achilles tendon, while the other had a prominent flexor hallucis longus tendon partially obliterating Kager's fat. The remaining 13 cases with accessory soleus muscles were evaluated for Achilles tendon abnormalities.There were 13 cases of accessory soleus muscles in 11 patients; two patients had bilateral accessory soleus muscles (the only study patients with bilateral MR examinations in our sample). There were five male and six female patients ranging from 15 to 81 years of age (mean 48). There were nine cases (69.2%) in which Achilles tendonopathy was associated with accessory soleus muscle, including tendonopathy of each Achilles tendon in the two patients with bilateral accessory muscles.In our small patient population, there was a high association between accessory soleus muscle and Achilles tendonopathy.