We report a case of Achilles tendinosis that was treated with a high volume, hydrodissection visualized by conventional B-mode ultrasound. Prior MRI revealed a thickened right Achilles tendon with a small defect. Ultrasound examination showed a thickened Achilles tendon with physical exam revealing a prominent Haglund’s deformity, mild fusiform swelling and pain along the posterior Achilles (Figure 1 & 2). The condition had been poorly responsive to standard management including protected ambulation in a cam walker boot, anti-inflammatory medication, modalities and therapeutic exercise, as well as a platelet rich plasma injection. We suggest using high volume ultrasound guided injection adjacent to (anterior to) the Achilles tendon as an adjunct to treat this difficult clinical syndrome.