Painless extensive ossification of the Achilles tendon: a diagnostic trap?
1Department of Neurosurgery, Avicenne Military Hospital, Marrakech, Morocco, 2University of Mohammed V Souissi, Rabat, Morocco
Ali Akhaddar, Department of Neurosurgery, Avicenne Military Hospital, Marrakech, Morocco
A 52-year-old man, previously healthy with no known metabolic or systemic illness,
presented acutely following a direct trauma of the right foot. On examination
there was soft tissue swelling and tenderness around the dorsum of the foot
without neurological deficit. Plain radiography of the foot and the leg revealed
a 10 centimeters ossification within the right Achilles tendon without fracture.
The patient had no previous ankle problems. Local examination revealed a painless
palpable gap and hard edges in the Achilles tendon but there are
no disorders in walking. Because the patient was asymptomatic, no surgery was
performed. Ossification of the Achilles tendon is an unusual clinical condition
to be distinguished from the more frequently occurring tendon calcification.
It is characterized by the presence of one or more segments of variable sized
ossified mass within the fibrocartilaginous substance of the Achilles tendon.
The etiology of this local ossification is unknown. The major contributing
factors are trauma (especially repetitive microtrauma) and surgery with other
minor causes such as systemic diseases, metabolic conditions, and infections.
A large and extensive ossification for more than half of the tendon is rare
and should not be misdiagnosed as a fracture or a foreign body particularly
following an injury.
: Plain radiographs of the right leg and ankle. Lateral view (A) and antero-posterior (B) view revealing a 10 centimeters ossification within the right Achilles tendon without fracture