Rare Case of Bilateral Tendoachilles Rupture after Local Steroid Infiltration

The causes for the painful heel around the Achilles tendon are Achilles tendinitis and retrocalcaneal bursitis. The treatment modalities range from simple NSAID’s, hot water fomentation, ultrasound phonopheresis, and intralesional steroids to surgery. There is a debate on giving intralesional steroids in and around the Achilles tendon. Most common complication of intralesional corticosteroids injection is rupture of the tendon. Here is a case of bilateral tendoachilles rupture due to intralesional corticosteroid infiltration. A 40 year old female suffering from bilateral retrocalcaneal bursitis since seven years was treated with two doses of intralesional steroid bilaterally around tendoachilles at interval of one month, four and three months prior to rupture. One month back patient had rupture of bilateral tendoachilles. This was confirmed by ultrasound and MRI examination. We treated the rupture using Krackow’s technique to repair the tendon. Follow up at one year revealed good functional outcome. Bilateral tendoachilles rupture due to corticosteroid infiltration is very rare. Better to avoid intralesional steroid injections in and around the tendoachilles. MRI and ultrasound are confirmatory. MRI is more sensitive than ultrasound, but due to cost USG is the preferred investigation. Histopathological investigation reveals the tendon end to be degenerated; thereby chronic ruptures should be repaired surgically, which reduces chance of failure and improves functional outcome. Bilateral cases are to be operated in two sittings to avoid complications caused due to prolonged immobilization.