A case of spontaneous bilateral Achilles tendon rupture: surgical treatment with early mobilization

Tendo-Achilles (TA) rupture is the most commonly ruptured tendon in the lower limb despite being one of the toughest tendons. Typically, it occurs unilaterally in middle-aged individuals who participate in strenuous activity. Spontaneous ruptures without any risk factors predisposing the patient is uncommon and for it to occur bilaterally is very rare.

To raise awareness of the potential for TA ruptures to occur bilaterally and thus the importance of assessing the TA contralateral to a seemingly unilateral rupture. This is particularly the case in patients with risk factors, which are reviewed in this report. A summary of the main treatment options is also described.

We report a case of spontaneous, bilateral TA rupture in a 40-year-old man with no identifiable risk factors. It occurred following a heavy impact during a sports activity and although painful, was able to mobilize slowly. After a clinical examination confirmed the diagnosis, the patient underwent early bilateral surgical repair and subsequently embarked on a comprehensive rehabilitation program with a good functional outcome at follow-up. His return to premorbid work and social life was uneventful.

Bilateral TA ruptures are rare but increased awareness would help avoid a tear or rupture of the contralateral side being missed. All patients presenting clinically with any TA rupture should have risk factors reviewed. Surgical repair must be accompanied by a comprehensive rehabilitation program for adequate recovery and return of function.