Extensive Atraumatic Heterotopic Ossification of the Achilles Tendon in an Adolescent with Metabolic Syndrome

Abstract

Case: A 15-year-old boy with type 1 diabetes mellitus, hypertension, and obesity presented with atraumatic posterior ankle pain and stiffness due to extensive heterotopic ossification (HO) of the Achilles tendon. The ossification was successfully surgically resected and tendon primarily repaired. Wound dehiscence was noted at the first preoperative visit, managed conservatively by local wound care, and healed uneventfully by secondary intention. One-year follow-up showed no recurrence of HO, return to baseline activities, yet low Oxford scores. Conclusion: HO of the Achilles tendon is a rare clinical entity. We report an atraumatic case in an adolescent patient with metabolic syndrome, which may demonstrate systemic inflammation because of metabolic syndrome as a risk factor for HO.

Acute fracture of an extensively ossified segment of the Achilles tendon

“…Moreover, atraumatic cases of TO of the Achilles include patients with obesity, runners and manual workers1; suggesting repetitive loading stress, or metabolic syndrome, potentially associated with systemic inflammation,12 could contribute to its pathogenesis. A PubMed search for associations between TO and each of APLS, SLE and EDS returns no relevant entries pertaining to this case.…”