Achilles tendon ossification after treatment with acitretin

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

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.

Ossification of the Interosseous Membrane of the Leg in a Football Player: Case Report and Review of the Literature

Introduction. We report a case of ossification of the interosseous membrane (OIM) of the leg in a football player who had no history of severe local traumas. A review of the literature of the OIM of the leg in athletes was also carried out. Case Report. A 38-year-old Caucasian male patient complained of pain on lateral aspect of the leg when playing football. Pain progressively worsened until he had to stop the sporting activity. Radiographs, and then CT and MRI, showed OIM in the middle third of the left leg. MRI showed inflammation of tibia periosteum and bone adjacent to the ossification, which was then excised. Two months after surgery the patient returned to play football. Conclusion. A thorough analysis of the literature revealed three types of OIM of the leg in athletes. Type I usually occurs after a syndesmosis ankle sprain, Type II appears to result from a tibia fracture, and Type III, of which only one fully recorded case has been published, is probably caused, as in our patient, by repetitive minor traumas to the leg. Awareness of the existence of Type III OIM can avoid erroneous diagnoses leading to useless investigations and treatments.

Multiple intratendinous ossified deposits of the Achilles tendon: Case report of an unusual pattern of ossification

True ossification of the Achilles tendon is a rare condition as compared to calcification. The etiology of ossification is multifactorial, however, previous surgery, trauma and degenerative changes have been attributed to be the major causes. Three different patterns of ossification have been described within the Achilles tendon based on their location. We present a case of multiple discrete deposits of ossification within the main substance of the Achilles tendon in a young male with a previous history of clubfoot surgery in childhood. The pattern of ossification was different than all the previously reported cases. Pain was the predominant symptom. He was investigated by using plain radiographs, ultrasonography, computed tomography and magnetic resonance imaging. Surgical excision of all the bony lumps lead to satisfactory outcome without any complications.

An atraumatic case of extensive Achilles tendon ossification

BACKGROUND

Ossification of the Achilles tendon is rare with most cases of ossification or calcification consisting of small, focal lesions. This pathology is usually predisposed by surgery, trauma, or other factors.

CASE DESCRIPTION

A case of extensive Achilles ossification and calcification, without prior surgery or trauma, is reported. Following removal of one of the largest ossific masses reported in the literature, measuring 11.0cm×2.5cm×2.0cm with additional 6.5cm calcifications, surgical reconstruction was required.

PURPOSE AND CLINICAL RELEVANCE

The objective of this report was to describe an unusual case of Achilles tendon ossification and calcification that occurred without the presence of predisposing factors. When a large gap is present after removal of the ossification, direct repair may be impossible and V-Y lengthening plus flexor hallucis longus (FHL) transfer is a viable option for pain relief and return to function.