A Rare Case of a Fracture of Massive Ossification of the Achilles Tendon

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Abstract

Massive ossification of the Achilles tendon is a relatively rare condition that is usually associated with an old open or closed injury. In addition, it may be caused by infections or metabolic and systemic diseases, such as syphilis, gout, diabetes, Wilson disease, reactive arthritis, or ankylosing spondylitis. The exact pathogenesis of this condition is still not fully understood. A fracture of the ossified Achilles tendon is an even rarer condition that often leads to limb dysfunction, severe local edema, and pain syndrome that resembles an acute Achilles tendon rupture. Two recent reviews found that only a few dozen cases have been reported over the past 100 years, with a variety of treatment options and outcomes. Currently, there is no widely accepted treatment algorithm for patients with this condition. The article presents a surgical treatment option involving complete excision of both ossified fragments and the transposition of the flexor hallucis longus. These results suggest a treatment strategy for patients with this fracture of the ossified Achilles tendon.

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About the authors

Nikita S. Konovalchuk

Vreden National Medical Center for Traumatology and Orthopedics

Author for correspondence.
Email: konovalchuk91@yandex.ru
ORCID iD: 0000-0002-2762-816X
SPIN-code: 5278-1271

MD, Cand. Sci. (Medicine), orthopedic surgeon, depart. No. 15

Russian Federation, 8 Academician Baykova st, depart. No. 15, Saint Petersburg, 195427

Evgenii P. Sorokin

Vreden National Medical Center for Traumatology and Orthopedics

Email: epsorokin@rniito.ru
ORCID iD: 0000-0002-9948-9015
SPIN-code: 5268-5290

MD, Cand. Sci. (Medicine), orthopedic surgeon, head, depart. No. 15

Russian Federation, 8 Academician Baykova st, depart. No. 15, Saint Petersburg, 195427

Ekaterina A. Pashkova

Vreden National Medical Center for Traumatology and Orthopedics

Email: eapashkova@rniito.ru
ORCID iD: 0000-0003-3198-9985
SPIN-code: 2949-5308

MD, Cand. Sci. (Medicine), orthopedic surgeon, depart. No. 15

Russian Federation, 8 Academician Baykova st, depart. No. 15, Saint Petersburg, 195427

References

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Supplementary files

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2. Fig. 1. Depression area between the two hard fragments at the Achilles tendon (a). The scar and significant asymmetry compared to the healthy side (b).

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3. Fig. 2. Radiograph of the left ankle joint in lateral view (a). Magnetic resonance imaging of the ankle joint in sagittal view (b).

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4. Fig 3. Both ossification fragments after excision, with a total length of 12 cm (a). The flexor hallucis longus before insertion into the calcaneal canal (b).

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5. Fig. 4. Histopathology of a section of the excised fragment.

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6. Fig. 5. Magnetic resonance imaging of the ankle joint in a horizontal view at the same level, both before (a) and six months after (b) surgery, reveals hypertrophy of the belly of the flexor hallucis longus.

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