Painless rupture of the Achilles tendon in a diabetic patient with sensory neuropathy

Abstract

We describe a 71‐year‐old female diabetic patient with sensory distal lower limb neuropathy, who presented with painless swelling and erythema of the left ankle and lower shin. Diagnoses of cellulitis, deep venous thrombosis and Charcot neuroarthropathy were considered, but eventually a magnetic resonance scan showed complete rupture of the Achilles tendon. There was no history of trauma, and the absence of pain was presumed to be due to her dense sensory neuropathy. Copyright © 2007 John Wiley & Sons.

Spontaneous rupture of the peroneus longus tendon in a patient with diabetic sensory neuropathy

“…Tendon morphology and micro‐scopy may be abnormal in diabetes,5 possibly as a result of protein glycosylation related to long‐term hyperglycaemia 6. This may lead to spontaneous rupture, which in the presence of sensory neuropathy may be painless, and remain unnoticed until swelling occurs,1 as in our case.…”

“…Myonecrosis of the peroneus longus and brevis muscles has been described 7. The outcome of tendon pathology in diabetes is not well known, but conservative management can be successful 1…”

“…When sensory neuropathy is present, even complete rupture can be painless. Tendons in relation to the ankle joint are usually involved, for example, the Achilles tendon1 or the tendon of tibialis anterior 3,4. We present here a case of painless rupture of the peroneus longus tendon in a patient with diabetes‐related distal symmetrical sensory neuropathy.…”

“…Tendinitis and tendon rupture may occur more commonly in patients with diabetes mellitus 1–4. When sensory neuropathy is present, even complete rupture can be painless.…”