Bilateral Spontaneous Achilles Tendon Rupture without Any Predisposing Factors

Besides spontaneous rupture of achilles tendon is a rare condition which is usually associated with corticosteroid or fluoroquinolon usage. Spontaneous rupture of achilles tendon without any risk factors is extremely rare. In this report we aimed to present clinical features of a case of bilateral spontaneous achilles tendon rupture and tried to investigate potential etiologic factors. A 54-year-old man was admitted to our emergency department as complaining bilateral ankle pain at the retrocalcaneal region. He had no trauma, any comorbidities or any drug consumption history. Painful achilles tendon gaps proximal to his ankles had been palpated and bilateral Thompson’s test positivity had been noted (Figures 1 and 2). He was unable to rise upon his toes however he was able to walk. American Orthopedic Foot and Ankle Society Hindfoot Scoring was calculated as 78 points. The rupture had been verified with a magnetic resonance imaging and his laboratory findings were all within normal limits (Figures 3 and 4). The patient did not approve an operation so conservative treatment with dorsiflexion limiting brace was applied and strengthening and stretching exercises of gastrosoleus was suggested. Atraumatic and bilateral cases with achilles rupture should be well investigated whether any systemic factors are coexistent. Besides well known corticosteroids or fluoroquinolone exposure, endocrinologic and rheumatological diseases, hypercholesterolaemia should be evaluated in terms of predisposing causes. Patients who have to use corticosteroids or fluoroquinolone, should be informed about achilles tendon rupture and be suggested do regular physical exercises in order to reduce the rupture risk. Despite predisposing factors, sometimes nothing can be associated with achilles tendon rupture as in our case. Genetic predisposition or a degenerative process of a tendon due to age may be underlying cause like in rotator cuff tears.