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Acute fracture of an extensively ossified segment of the Achilles tendon
  1. Charles Hillman1,2,
  2. Jitendra Mangwani3 and
  3. Stefan Kluzek1,4
  1. 1Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2Orthopaedics, Trauma and Sports Medicine, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
  3. 3Orthopaedic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
  4. 4Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Charles Hillman; charles.hillman{at}


Extensive tendon ossification is thought to be rare and is hypothesised to occur due to cell-mediated tissue remodelling. Literature outlining risk factors for the development of an ossified segment, and then a consequent fracture is limited to case reports and case series. A woman in her fifties with a background of several autoimmune disorders presented to a sports and exercise medicine clinic with posterior ankle pain following a bout of brisk walking a month prior. CT and MRI imaging demonstrated a fractured extensively ossified segment of the corresponding Achilles tendon. Conservative treatment was trialled for six months, however, was unsuccessful. Surgical excision of the calcified fragment and flexor hallucis longus tendon transfer were suggested as a potential solution. This case is compared with and builds on current literature surrounding pathophysiology and optimal treatment of extensively ossified segments of the Achilles tendon.

  • Tendon rupture
  • Achilles tendinitis
  • Sports and exercise medicine

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  • SK and JM are joint senior authors.

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: all authors. The following authors gave final approval of the manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests JM is the honorary secretary for the British Orthopaedic Foot and Ankle Society. He also holds a consultancy agreement with Orthosolutions and Meshworks.

  • Provenance and peer review Not commissioned; externally peer reviewed.