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.

Share and Cite:

E. Uygur, S. Erinç, H. Çift, F. Özkan and S. Söylemez, "Bilateral Spontaneous Achilles Tendon Rupture without Any Predisposing Factors," Open Journal of Orthopedics, Vol. 2 No. 3, 2012, pp. 117-120. doi: 10.4236/ojo.2012.23021.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Parmar, K.P. Meda, “Achilles Tendon Rupture Associated With Combination Therapy Of Levofloxacin And Steroid In Four Patients And A Review Of The Literature,” Foot & Ankle International, Vol. 28, No. 12, 2007, pp. 1287-9.
[2] Z. Khanzada, U. Rethnam, D. Widdowson, A. Mirza, “Bilateral Spontaneous Non-Traumatic Rupture Of The Achilles Tendon: A Case Report,” Journal Of Medical Case Reports,” Vol. 30, No. 5, pp. 263.
[3] G.P. McComis, D.A. Nawoczenski, K.E. DeHaven, “Functional Bracing For Rupture Of The Achilles Tendon. Clinical Results And Analysis Of Ground-Reaction Forces And Temporal Data”, Journal of Bone and Joint Surgery (Am). Vol. 79, No. 12, 1997, pp. 1799-808.
[4] G.W. Hess, “Achilles Tendon Rupture: A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention,” Foot & Ankle Specialist, Vol. 3, No. 1, 2010, pp. 29-32.
[5] Z. Hashim, Z. Dahabreh, M.T. Bin Jemain, H.R. Williams, “Bilateral Simultaneous Achilles Tendon Rupture In The Absence Of Risk Factors,” Foot & Ankle Specialist, Vol. 4, No. 3, 2011, pp. 175-8.
[6] S.K. Rao, B.C. Navadgi, A. Vasdev, “Bilateral Spontaneous Rupture Of Achilles Tendons: A Case Report,” Journal Of Orthopaedic Surgery,” Vol. 13, No. 2, 2011, pp. 178-80.
[7] G. Mathiak, J.V. Wening, M. Mathiak, L.F. Neville, K. Jungbluth, “Serum Cholesterol Is Elevated In Patients With Achilles Tendon Ruptures,” Archives Of Orthopaedic And Trauma Surgery, Vol. 119, No. 5-6, 1999, pp. 280-4.
[8] N. Basic-Jukic, I. Juric, S. Racki, P. Kes, “Spontaneous Tendon Ruptures In Patients With End-Stage Renal Disease,” Kidney And Blood Pressure Research, Vol. 32, No. 1, 2009, pp. 32-6.
[9] J.H. Park, S.B. Kim, H.S. Shin, G.H. Jung, Y.S. Jung, H. Rim, “Spontaneous And Serial Rupture Of Both Achilles Tendons Associated With Secondary Hyperparathy-roidism In A Patient Receiving Long-Term Hemodialysis,” International Urology And Nephrology, 2012.
[10] S.F. Habusta, “Bilateral Simultaneous Rupture Of The Achilles Tendon. A Rare Traumatic Injury,” Clinical Orthopaedics And Related Research, Vol. 320, 1995, pp. 231-4.
[11] R.R. Bailey, J.A. Kirk, B.A Peddie, “Norfloxacin-induced Rheumatic Disease,” The New Zealand Medical Journal, Vol. 27, No. 96, 1983, pp. 590.
[12] J.M. Casparian, M. Luchi, R.E. Moffat, D. Hinthorn, “Quinolones and Tendon Ruptures,” Southern Medical Journal, Vol. 93, No. 5, 2000, pp. 488-491.
[13] R.M. Harrell, “Fluoroquinolone-induced Tendinopathy: What Do We Know?,” Southern Medical Journal, Vol. 92, No. 6, 1999, pp. 622-625.
[14] Stinner DJ, Orr JD, Hsu JR. Fluoroquinolone-Associated Bilateral Patellar Tendon Rupture: A Case Report And Review Of The Literature. Military Medicine, Vol. 175, No. 6, 2010, pp.457-9.
[15] P.D. Van der Linden, M.C. Sturkenboom, R.M. Herings, H.M. Leufkens, S.S. Rowlands, B.H. Stricker, “Increased Risk Of Achilles Tendon Rupture With Quinolone Antibacterial Use, Especially In Elderly Patients Taking Oral Corticosteroids,” Archive Of Internal Medicine, Vol. 163, No.15, 2003, pp.1801-7.
[16] S. Syed, A. Bhatti, M.M Shah, “Spontaneous Atraumatic Achilles Tendon Rupture In Healthy Individuals: Biomechanical Aspect,” Journal Of Journal of College of Physicians and Surgeons Pakistan, Vol. 19, No. 3, 2009, pp. 195-7.
[17] E. Bass, “Tendinopathy: Why The Difference Between Tendinitis And Tendinosis Matters,” International Journal of Therapeutic Massage and Bodywork, Vol. 5, No. 1, 2012, pp. 14-17.
[18] S.H. Han, J.W. Lee, G.P. Guyton, B.G. Parks, J.P. Courneya, L.C. Schon, “J. Leonard Goldner Award 2008. Effect of Extracorporeal Shock Wave Therapy on Cultured Tenocytes,” Foot & Ankle International, Vol. 30, No. 2, 2009, pp. 93-98.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.