Rare Symptoms in Orthopedic Conditions: A Case Study

Rare symptoms

On October 31, 1992, I visited the hospital due to chondromalacia patellae.
The doctor instructed me to perform some stretching exercises and quadriceps training.
The next day (November 1), while doing the Achilles tendon stretching exercise, I heard a "pop" sound.
At the time, I didn't think much of it, but after a few days, I realized I was in so much pain that I couldn't wear shoes, so I went to see a rehabilitation specialist.
The initial diagnosis was bursitis.
After two months of rehabilitation with no improvement, the doctor conducted further examinations and discovered a rather rare condition.
He said that the Achilles tendon itself was not injured, but a portion of the tendon where it connects to the foot bone had been pulled away, which is considered a type of fracture.
Both feet were injured simultaneously.
The doctor recommended that I wear a cast for six weeks to three months.
I would like to ask how this condition is referred to? Have you encountered such cases before? What is the recommended treatment? Thank you for your response!

A Dong, 30~39 year old female. Ask Date: 2004/03/04

Dr. Shi Guozheng reply Orthopedics

This type is called a tear fracture.
If the displacement is not severe, it can be treated with a cast.
Of course, the cast should remain on until healing occurs, which typically takes about six to twelve weeks.

Reply Date: 2004/03/04

More Info

Your case presents a unique and complex situation that requires a thorough understanding of orthopedic conditions, particularly those related to tendon injuries and their implications. Based on your description, it seems you have experienced a rare condition following your initial diagnosis of patellar chondromalacia. The symptoms you are experiencing, particularly the "popping" sound during stretching and subsequent pain that prevents you from wearing shoes, suggest a possible tendon-related injury, specifically involving the Achilles tendon or the posterior tibial tendon.

The term you might be looking for to describe your condition could be "tendinopathy" or "tendon rupture," particularly if the tendon has been partially torn or if there is a significant strain at the junction where the tendon attaches to the bone. In your case, the fact that both feet were affected simultaneously is indeed unusual and could indicate a systemic issue or a biomechanical factor that predisposed you to this injury.

In terms of treatment, your doctor’s recommendation to use a cast for six weeks to three months is a common approach for managing tendon injuries, especially if there is a risk of further damage or if the tendon needs to heal in a protected environment. Immobilization allows the tendon to heal properly without the risk of re-injury. During this period, physical therapy may also be beneficial once the initial healing has occurred, focusing on gradual strengthening and flexibility exercises to restore function.

It is also essential to consider the underlying factors that may have contributed to your injury. For instance, if you have a history of patellar chondromalacia, it may indicate that your knee mechanics are altered, which can affect how forces are transmitted through your lower extremities during activities. This could lead to compensatory movements that place additional stress on the tendons of the foot and ankle. A thorough biomechanical assessment by a physical therapist or orthopedic specialist may provide insights into any abnormalities in your gait or foot mechanics that need to be addressed.

In rare cases, if conservative treatments such as immobilization and physical therapy do not yield satisfactory results, surgical intervention may be considered. This could involve repairing the tendon or addressing any underlying structural issues in the foot or ankle.

Lastly, it is crucial to maintain open communication with your healthcare provider throughout this process. Given the rarity of your symptoms, seeking a second opinion or consulting with a specialist in sports medicine or orthopedic surgery may provide additional insights and treatment options tailored to your specific condition.

In summary, your symptoms appear to be related to a rare tendon injury, possibly involving tendinopathy or a partial rupture. The recommended treatment of immobilization with a cast is appropriate, and further evaluation of your biomechanics may be necessary to prevent future injuries. Always consult with your healthcare provider for personalized advice and treatment options.

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