Heterotopic Ossification of the Achilles Tendon in a Patient with Type II Diabetes Mellitus: A Case Report and Comprehensive Management Overview.

ABSTRACT

Introduction: Heterotopic ossification of the Achilles tendon (HOTA) is a rare but consequential complication to an inflammatory event, often presenting challenges in diagnosis and management. Case Report We report a case of a 42-year-old male with Type II diabetes mellitus, managed with Metformin, who presented with acute pain and swelling in the right ankle following a running activity. Clinical examination revealed tenderness and a visible swelling proximal to the calcaneum attachment of the tendon which was hard in consistency, and a positive Thompson test indicative of a potential Achilles tendon injury. Imaging, including X-ray and magnetic resonance imaging, confirmed a complete avulsion tear with cranial retraction of the torn tendon and heterotopic ossification seen proximal to the torn end of the tendon. Surgical intervention, employing a posterior paramedian approach under tourniquet control, involved tendon approximation using the Speed bridge technique, incision over the proximal tendon and removal of the ossified tendon, and repair of the incised tendon sheath. Postoperatively, the patient received a tailored medication regimen and was advised strict non-weight-bearing measures, wound management, and limb elevation. The patient was discharged in a stable condition. Conclusion: This case underscores the importance of early recognition and prompt surgical intervention in managing HOTA, particularly in patients with underlying risk factors. The presented surgical approach and postoperative management contribute to the evolving strategies for addressing this rare clinically significant condition.