A 55-year-old female presented with difficulty walking for 2 months following a sudden popping sensation and pain in her left heel. Examination revealed a 2cm gap in her left tendo-achilles, wasting of her left calf muscle, and inability to perform toe walking or plantar flexion on her left foot. Tests were positive for Achilles tendon rupture. She was diagnosed with a 2-month old spontaneous rupture of her left Achilles tendon, and the treatment plan is reconstruction using a flexor hallucis longus tendon transfer secured with an interference screw.

1. Mohd. Tareq Anwar Shishir
MS Phase B Resident
Violet-1
WELCOME
TO THE MORNING SESSION CASE PRESENTATION

2. Particulars of the patient
• Name: Momotaz Begum
• Age: 55 years
• Sex: Female
• Address: Alamdanga, Chuadanga
• Date of admission: 08/12/22
• Ward/Bed no: GH/55

3. Chief complaints
Difficulty in walking for 2 months
Inability to run & jump for same duration

4. History of present illness
According to statement of the patient she was
reasonable well 2 months back. Then while she was
walking suddenly felt popping sensation and severe pain
back of left heel. After the incident she has difficulty in
walking by using left leg, and unable to run or jump, and
difficulty in upstairs & downstairs movement. For this
reason he came to NITOR for better management.

5. History of past illness
• No diabetes, hypertension.
• No history of local steroid injection.

6. Loco-regional examination
Look:
• Skin condition – normal.
• Visible wasting of right calf muscle.
• Gait – high steeping gait.
• Toe walking is not possible on left leg.

7. Feel:
• Local temperature – normal.
• 2 cm gap in left tendo-achilles.
• Wasting of left calf muscle – about 2 cm.

8. Special tests:
• Thompson/Simmond squeeze test: Positive.
• Matles Test: Positive.
• O’Brien needle test: Not done.

9. Move: of left ankle.
• Plantar flexion: Weak.
• Other movements are normal.
Distal neurovascular status: Intact.

10. Matles Test

11. Radiology

12. Salient Feature
Momotaz Begum, 55 years old female presented
with the complaints of diffuculty in walking for 2
months following a sudden feeling of popping
sensation and severe pain in back of left heel. She
also complained of inability to run or jump and
difficulty in upstairs and downstairs movements.
She is non-diabetic and normotensive and has no
history of local steroid injection. Her general and
systemic examinations revealed no abnormality.

13. On loco-regional examination: gait is high
stepping, toe walking not possible, overlying skin
condition is normal, 2 cm gap in affected tendo-
achilles, about 2 cm wasting of left calf muscle.
Thompson squeeze test and Matles test are
positive. O’Brien needle test is not done.
All movements of left ankle are normal except
weak planter flexion.
Distal neurovascular status is intact.

14. Diagnosis
2 months old spontenous rupture of left Tendo
Achilles

15. Unit plan
Reconstruction of Achilles Tendon
(FHL—Flexor Hallucis Longus tendon
transfer to heel by interference screw)

16. Thanks