Achilles tendon rupture in previously treated clubfoot: Is there a correlation? A pediatric case report and a literature review

Backgrounds: Achilles tendon rupture in children is very rare. The cause could be traumatic or non-traumatic such as clubfoot deformity, auto-immune, infectious or genetic diseases with collagen alterations. Regarding clubfoot, only a few case reports of Achilles tendon injury in previously treated feet diagnosed with this deformity are available in the literature. The most accepted treatment for clubfoot is represented by the Ponseti method which includes manipulations, corrective casts and Achilles tendon tenotomy. After surgery, the tendon fibres appear to heal properly. Case report: We present the case of a 14-year-old girl who was referred to the emergency department for intense right ankle pain aroused while running, which resulted in a ruptured Achilles tendon. She had a history of bilateral clubfoot previously treated in her neonatal age with the Ponseti method including Achilles tendon tenotomy. The actual tendon lesion was treated surgically with an open terminus-terminal tenorrhaphy and immobilisation with a cast. Full recovery occurred after 2 months. Discussion and conclusions: This study presents a rare case of Achilles tendon injury in previously treated clubfoot. Treatment of clubfoot is necessary to avoid invalidating sequelae. Achilles tenotomy is a widely accepted and effective procedure and studies have shown that tendon quality and muscle strength at week 12 are comparable to those of a normal tendon and the remodelling process continues up to three years later. Further studies are needed to investigate the possible link between clubfoot treatment and the later rupture of the Achilles tendon.