A silent massive ossification of Achilles tendon as a suspected rare late effect of surgery for club foot

Abstract

We report the case of a 66-year-old male patient with massive ossification of the distal portion of the Achilles tendon, as a late consequence of a surgical release for club foot conducted in his childhood. The singularity of the case report derives from its clinical features: the bone mass was of abnormal dimensions, almost substituting the entire tendon; the condition had always been asymptomatic, without deficits in range of motion, in absence of either pain or biomechanical defects with age. In fact, the condition was diagnosed just recently as a consequence of a tear. Despite an ultrasound diagnosis after the injury, only during the surgical treatment, a proper evaluation of the entity of the pathology was possible. Although the ossification of Achilles tendon is a rare clinical condition with a complex multifactorial etiology, in our case report, some of the elements in the patient’s medical history could be useful for the pathogenesis and early diagnosis of the disease. The aim of this case report is to emphasize the importance both of a correct evaluation of clinical history and of an accurate diagnosis, in order to conduct a proper management of this pathology.

Extensive Ossification of the Achilles Tendon with and without Acute Fracture: A Scoping Review

“…Brotherton et al and Mallinson et al describe a technique wherein the ends of a fractured tendon can be brought and held together with a wire [18,19]. However, more commonly, the ossified segments of the Achilles are removed, with the remaining tendon ends reconnected with a tendon graft [4,5,10,[13][14][15]. Tendons from the flexor hallucis longus, hamstring, semitendinosus, gracilis, fascia lata, plantaris, and fascia overlying gastrocnemius-soleus muscle have all reportedly been used as tendon autografts [5,12,13,15] with no allografts or xenografts being used in the reports.…”

Acute fracture of an extensively ossified segment of the Achilles tendon

“…Numerous cases of Achilles ossification describe previous corrective surgery for tallipes equinovarus, which is a common indication for Achilles tenotomy 13–16…”

Delayed Achilles Tendon Rupture at 17 Years of Age After Treatment of Clubfoot with Ponseti Method

“…In both cases, intraoperative findings included a significant amount of scar tissue at the distal end of the tendon. Moreover, Pedrotti et al 17 and Manfreda et al 18 reported calcification and rupture of the Achilles tendon in adults with a history of treatment for clubfoot. Although these cases differed from the present case in that they had previously undergone more invasive surgery, we believe that the pathophysiology of calcification and rupture because of degeneration of the Achilles tendon is similar to that of the present case.…”