Rupture of Achilles Tendon after Steroid Injection in Achilles Tendinitis (A Report of Five Cases) / 대한족부족관절학회지

PURPOSE: The purpose of the study was to investigate five cases with chronic Achilles tendon rupture that occurred after steroid injections. MATERIALS AND METHODS: In our hospital, we experienced five cases of chronic Achilles tendon rupture from September 2010 to March 2012. All patients had got steroid injection for Achilles tendinitis at the other hospitals, and their heel pain was aggravated when they visited our outpatient department. After treatment, signs and symptoms of Achilles tendon rupture were developed and the diagnosis was confirmed by ultrasonography or magnetic resonance imaging (MRI). Surgical treatment was done for Achilles tendon rupture. RESULTS: There was difference between intra-operative findings of Achilles tendon rupture and usual chronic Achilles tendon rupture. Unlike usual findings of chronic Achilles tendon rupture whose scar tissue or tissue attenuation are found around the defect area of Achilles tendon, there were partial necrosis of tendon severe adhesion with surrounding tissue, extensive defect and longitudinal rupture on ruptured area. Also, severe inflammation of paratenon, granulation and fibrinoid deposit were found on biopsy findings in four cases. CONCLUSION: Based on review of data about relative risk and benefit of local corticosteroid injection to inflammatory lesion in Achilles tendon, it requires more attention to Achilles tendon rupture following local corticosteroid injection.

Levofloxacin-Induced Achilles Tendinitis in a Young Adult in the Absence of Predisposing Conditions

Fluoroquinolones (FQs) represent a major class of antimicrobials that have a high potential as therapeutic agents. Although FQs are generally safe for the use as antimicrobials, they may induce tendinopathic complications such as tendinitis and tendon rupture. A number of factors have been suggested to further predispose a patient to such injuries. Hitherto, a few published cases on tendon disorders have implicated levofloxacin, a more recently introduced FQ. Here, we report a patient with levofloxacin-induced Achilles tendinitis, who exhibited no known predisposing factors. A 20-year-old man without any history of disease or medication presented with community-acquired pneumonia. Levofloxacin was administered and 3 days later, he complained of pain in the left Achilles tendon and revealed redness and swelling in the area. On suspecting Achilles tendinitis, levofloxacin treatment was discontinued, and the tendinitis subsequently improved. To our knowledge, this is the first case report on FQ-induced Achilles tendinitis in Korea.

Radiological Change of Kager's Triangle in Patients with Retrocalcaneal Disorders / 대한족부족관절학회지

PURPOSE: The aim of this study was to analyze radiological change of Kager's triangle in patients with retrocalcaneal disorders. MATERIALS AND METHODS: Areas of Kager's triangle and calcaneus were calculated with Heron's Formula. Average of area ratio (area of Kager's triangle / area of calcaneus) was calculated for comparison and analysis, according to disease activity and aging process. One-tailed Z-test was done with the average of area ratio. RESULTS: Average of area ratio (area of Kager's trianlge / area of calcaneous) tends to decrease according to aging process and disease existence. CONCLUSION: Because area of Kager's triangle in patients with retrocalcaneal disorders tends to change according to disease activity and aging process, we should consider clinical correlation between the anatomical structure of Kager's triangle and retrocalcaneal symptoms.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.

Clinical Utility of Radiographic Measurements of Insertional Achilles Tendinitis with Haglund's Deformity / 대한족부족관절학회지

PURPOSE: It is to analyze the clinical utility of radiograhpic measurements for the insertional Achilles tendinitis patients who have Haglund's deformity and to evaluate the radiographic values related to Haglund's deformity in normal Korean population. MATERIALS AND METHODS: We used the angle of Fowler and Philip, parallel pitch lines (PPL) and Chauveaux-Liet (CL) angle as radiographic measurements. We examined 50 cases of insertional Achilles tendinits patients and another 50 cases of normal foot as a control. RESULTS: In normal feet, the mean value of angle of Fowler and Philip was 53.22 degrees, CL angle was -33.14 degrees and the PPL showed positive in 48%. In case of insertional Achilles tendinitis, the mean values were 55.39 degrees, -33.63 degrees, positive in 56% respectively. There were not statistically significant differences (p>0.05). CONCLUSION: The radiographic values for Haglund's deformity between insertional Achilles tendinitis feet and the normal feet did not show significant difference. Therefore, it seems that the clinical utility of radiographic measurements for the insertional Achilles tendinitis with Haglund's deformity is not useful and the development of new diagnostic methods as MRI and ultrasonography is required.

Surgical Treatment of Tuberculous Achilles Tendinitis: Case Report / 대한족부족관절학회지

Although Achilles tendinitis is a relatively common disease, tuberculous involvement of Achilles tendon is rare. We report a case of tuberculous Achilles tendinitis, which was successfully treated with chemotherapy and a combined surgical procedure (Achilles tendon parital excision and FHL tendon transfer).

Surgical Treatment of Tuberculous Achilles Tendinitis: Case Report / 대한족부족관절학회지

Although Achilles tendinitis is a relatively common disease, tuberculous involvement of Achilles tendon is rare. We report a case of tuberculous Achilles tendinitis, which was successfully treated with chemotherapy and a combined surgical procedure (Achilles tendon parital excision and FHL tendon transfer).

Ultrasonographic Assessment of Calcaneal Enthesopathies in Seronegative Spondyloarthropathies / 대한류마티스학회지

OBJECTIVE: To determine the diagnostic value of ultrasonography (US) in detection of calcaneal enthesopathies and compare US findings with clinical examination and laboratory data in patients with seronegative spondyloarthropathy (SpA). METHODS: We studied fifty six patients with SpA (ankylosing spondylitis 51; psoriatic arthritis 2; reactive arthritis 3). Gray scale US and power Doppler sonography (PDS) was performed in Achilles tendons and plantar fascia using a 40 mm, 12 MHz linear probe to detect tendon thickness, loss of normal fibrillar echogenecity, blurred tendon margin, calcification, fluid collection around tendon, bony erosion, enthesopathic spur, retrocalcaneal bursitis and increased vascularity. Clinical examination including Mander enthesis index (MEI) score, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were examined at the same time. RESULTS: In 112 Achilles tendons, 72.3% showed abnormal US findings, as followings, increased tendon thickness 50.9%; loss of normal fibrillar echogenecity 32.1%; blurred tendon margin 24.1%; calcification 5.4%; fluid collection around tendon 17.7%; bony erosion 16%; enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US enthesopathic spur 8.9%; retrocalcaneal bursitis 13.4%; and increased vascularity in power Doppler sonography (PDS) 14.2%. In 112 plantar aponeurosis, 59.8% showed abnormal US findings, as followings, increased tendon thickness 12.5%; loss of normal fibrillar echogenecity 50%; blurred tendon margin 30.3%; bony spur 2.7%; and increased vascularity in PDS 4.5%. PDS findings well correlated with findings of gray scale US. While 46% of symptomatic patients and 41.2% of patients with tenderness have abnormal X-ray findings, 69.4% of symptomatic patients and 73.8% of patients with tenderness have abnormal US findings. Patients with clinical symptoms, elevated CRP level and >1 MEI score showed increased vascularity in PDS. CONCLUSION: US is a simple and useful method in the detection of enthesopathies of SpA, even in patients without clinical symptom nor abnormal radiographic finding, and PDS combined with gray scale US is more sensitive tool which reflects the clinical examination.