Acute fracture of extensive Achilles tendon calcific tendinopathy
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Daniel Sullivan
In May 2020, a 72 year old man presented to an outpatient orthopedic sports medicine clinic with a 3 week history of right ankle pain that began while mowing his lawn. One week after the onset of pain, the patient felt a “pop” and experienced subsequent bruising, swelling, and tenderness to his right lower leg. Walking was limited to short strides. At 2 years old, he underwent right lower leg surgery to correct in-toeing but had been asymptomatic since. Upon presentation to the orthopedic sports medicine clinic, the patient’s Achilles tendon had an indurated, “woody” feel. Full range of motion was intact, and a Thompson test was negative. An Achilles tendon total rupture score was not taken. The contralateral leg was unremarkable. Laboratory tests were not performed upon initial presentation but were unremarkable several months later. In-office ultrasound revealed a linear hyperechoic signal with a segment of discontinuity (Image A, green arrow). Plain radiographs and magnetic resonance imaging (MRI) demonstrated ossification of the Achilles tendon with a fracture of the ossified mass (Image B, red arrow; Image C, blue arrow). The patient agreed to a trial of nonsurgical treatment involving home exercises for range of motion, nonsteroidal anti inflammatory drugs (NSAIDs), and activity modification. Conservative treatment resulted in worse range of motion at the first follow up visit. The patient was then immobilized with a cast for 4 weeks and underwent physical therapy for several weeks thereafter. Five months after the inciting event, the patient reported no pain and full functionality.
Extensive calcification of the Achilles tendon with a subsequent fracture is exceedingly rare [1], [, 2]. As with this case, previous reports have described patients who experienced acute trauma affecting the Achilles tendon decades prior [2], [3], [4], [5]. A fracture of the calcified tendon may or may not result in a complete tendon rupture. Conservative and surgical treatments have both been reported. Conservative interventions include ice and heat application, range of motion exercises, oral and topical NSAIDs, orthotics, and physical therapy [6]. Surgical interventions include replacing the tendon with an autograft from the tensor fasciae latae [7], flexor hallucis longus tendon [2], or hamstring tendon [8].
Research funding: None declared.
Author contributions: Both authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; both authors drafted the article or revised it critically for important intellectual content; both authors gave final approval of the version of the article to be published; and both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests: Authors state no conflict of interest.
References
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© 2021 Daniel Sullivan and McKennan Thurston, published by De Gruyter, Berlin/Boston
This work is licensed under the Creative Commons Attribution 4.0 International License.
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- Editorial
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- Behavioral Health
- Original Article
- Predictors of emotional wellbeing in osteopathic medical students in a COVID-19 world
- Cardiopulmonary Medicine
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- Pediatrics
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