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Giant calcific insertional Achilles tendinopathy with Haglund's deformity following childhood tendon lengthening: a
Zhebang Li1, Wei Wei2, Zhongjun Yao1
1Department of Orthopaedic Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei Province, China.
Insights
This case study details a rare instance of extensive calcific insertional Achilles tendinopathy (CIAT) in a young adult, likely caused by prior surgery. Surgical intervention involving debridement and tendon transfer successfully restored function.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Research
Background:
- Calcific insertional Achilles tendinopathy (CIAT) is a rare condition involving calcium deposits at the Achilles tendon insertion.
- It typically affects older individuals, with rare occurrences in younger patients, especially with large lesions.
Purpose of the Study:
- To report a rare case of extensive CIAT in a young adult.
- To discuss the potential link to previous childhood surgery and surgical management.
Main Methods:
- A 36-year-old male with a history of Achilles tendon surgery presented with CIAT.
- Surgical treatment included debridement of calcific deposits, Haglund deformity resection, and flexor hallucis longus (FHL) tendon transfer.
- Histopathology revealed myxoid degeneration, neovascularization, and ossified tissue.
Main Results:
- The patient experienced significant improvement in pain, function, and range of motion at 3-month follow-up.
- Histopathology confirmed features consistent with chronic tendinopathy and ossification.
Conclusions:
- This case highlights delayed, extensive CIAT in a young adult, possibly secondary to prior surgical trauma.
- Combined surgical treatment (debridement, Haglund resection, FHL transfer) proved effective for functional restoration.
Background:
Calcific insertional Achilles tendinopathy (CIAT) is a rare and challenging condition characterized by calcium hydroxyapatite deposition at the Achilles tendon's calcaneal insertion. While typically affecting older individuals, its occurrence in younger patients is uncommon, particularly with large calcific lesions.
Case Presentation:
We report a rare case of a 36-year-old male presenting with progressive left Achilles tendon insertional pain and swelling. The patient had a history of Achilles tendon lengthening surgery in childhood. Imaging revealed large, multifocal calcific deposits within the tendon. Surgical intervention involved a posterior midline longitudinal approach with complete debridement of calcified lesions, Haglund deformity resection, and flexor hallucis longus (FHL) tendon transfer. Histopathology showed myxoid degeneration, neovascularization, and mature ossified tissue. At 3-month follow-up, the patient exhibited significant improvement in pain, function, and range of motion.
Conclusion:
This case highlights a rare presentation of delayed, extensive CIAT in a young adult likely related to previous surgical trauma and poor intraoperative hemostasis. It underscores the importance of recognizing the long-term sequelae of childhood tendon surgery and demonstrates the efficacy of a combined surgical strategy incorporating calcific debridement, Haglund resection, and FHL transfer for restoring function.
