Case reportMultiple intratendinous ossified deposits of the Achilles tendon: Case report of an unusual pattern of ossification
Introduction
Ossification of the Achilles tendon is an unusual clinical condition. Since its description in 1908, there have been sporadic reports of this condition in the literature [1]. It is described by the presence of an ossified mass either within the body of the tendon or at its insertion into the calcaneus [1], [2], [3]. The aetiology of the ossification remains unknown, however, review of the literature suggests that its aetiology is multi-factorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections [1], [4]. True ossification of the Achilles tendon with organised lamellar bone and trabecular bone is rare and is to be distinguished from more frequently occurring calcification [3]. There are three different patterns of ossification described within the Achilles tendon based on their location [5]. In its usual presentation, plain radiographs show ossification at the insertion of the Achilles tendon or a spur (fish-hook osteophyte) on the superior portion of the calcaneus. In contrast with calcification, ossification within the main body of the tendon is uncommon [6]. We present a case of a variable pattern of discrete multiple ossified deposits within the main substance of the Achilles tendon, who was assessed by plain radiographs, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI).
Section snippets
Case history
A 24-year old male presented with six-months history of multiple swellings over his right Achilles tendon. These were associated with progressively worsening pain during his day-to-day activities. There was no history of trauma, overuse or any systemic disease, however, during his childhood, he was treated for bilateral clubfeet and underwent Achilles tendon lengthening at the age of 3 years. The details of the surgical procedure were not available. On examination, multiple bony lumps were
Discussion
The true incidence of Achilles tendon ossification is unknown [3], [7] but it is twice as common in males than in females with no age predilection [8]. The mechanism of development of Achilles tendon ossification remains debatable. History of previous surgery, trauma and degenerative changes have been attributed in the development of ossification by some authors. Tamam et al. hypothesised that persistent lowering of the tissue oxygen tension causes the transformation of tendon into regions of
Conflict of interest
None declared.
References (15)
- et al.
Ossification of a ruptured achilles tendon: a case report in a diabetic patient
J Foot Ankle Surg: Off Publ Am Coll Foot Ankle Surg
(2002) - et al.
Could ossification of the achilles tendon have a hereditary component?
Case Rep Orthop
(2013) - et al.
Achilles tendon ossification: pathology, imaging and aetiology
Disabil Rehabil
(2008) - et al.
Ossification of the Achilles tendon – a case report
Scott Med J
(2005) - et al.
Classifications of radiopaque lesions of the tendo Achillhes
J Foot Surg
(1980) - et al.
Physiopathology of intratendinous calcific deposition
BMC Med
(2012) - et al.
Ossification of Achilles tendon – report of three cases
Arch Orthop Trauma Surg
(2002)
Cited by (5)
Ossification of calcaneal tendon: Plausible role of hypoxia-induced factor 1 alpha
2022, Journal of the Anatomical Society of IndiaAchilles tendon surgery in clubfoot: Are long term sequelae predictable?
2022, Pediatria Medica e ChirurgicaExtensive ossification of the achilles tendon with and without acute fracture: A scoping review
2021, Journal of Clinical MedicineAcute fracture of extensive Achilles tendon calcific tendinopathy
2021, Journal of Osteopathic MedicineAsymmetrical achilles tendon ossification and rare rear heel pain
2017, Australasian Medical Journal