Surgical Science, 2011, 2, 224-227 doi:10.4236/ss.2011.25050 Published Online July 2011 (http://www.SciRP.org/journal/ss) Copyright © 2011 SciRes. SS Conservative Management of Bilateral Tendoachilles (TA) Rupture—A Case Report Rahul Kakkar, Simon Chambers, Malcolm M. Scott North Tyneside General Hospital, Rake lane, North Shields, NE29 8NH E-mail: rahulkaks@rediffmail.com Received March 11, 2011; revised April 27, 2011; accepted May 5, 2011 Abstract Tendo Achilles ruptures are generally traumatic in origin and while bilateral tendo Achilles ruptures are a rare occurrence, most of them are associated with risk factors or pre-existing disease and generally involve trauma or sporting activities. Most of the cases of bilateral rupture are generally treated operatively. A spon- taneous onset case of bilateral tendo achilles rupture is reported in a healthy man and its conservative (non operative) management discussed with a review of the literature. Keywords: Bilateral Tendoachilles Rupture, Non-Traumatic, Spontaneous, Conservative Treatment, Cast Management 1. Introduction The Achilles tendon is the thickest and strongest tendon in the body [1,2] and although forces up to 12 times body weight can be tolerated by it, it still accounts for 20% of all large tendon ruptures [2]. Trauma and sporting activi- ties have been implicated as the most common cause of tendoachilles rupture [3,4] with the injury mechanism involving sudden and powerful contraction of the gas- trocnemius and soleus muscles on a dorsiflexed foot and usually affecting men aged 30 - 50 years [5]. But, spontaneous bilateral Achilles tendon ruptures are a rare occurrence [1,6-12] and account for about 1% of all Achilles tendon ruptures [9,11]. Risk factors for these type of injuries include corticosteroid use [12], limb ischemia [13], anabolic steroids [14], fluoroquinolones [15], chronic pain, previous Achilles tendon rupture [16] and rheumatoid arthritis, SLE [17] .To our knowledge, only a few reports on spontaneous bilateral Achilles ten- don tears have been published, most with associated risk factors but with satisfactory outcomes and there is only one other case report of a bilateral rupture of the tendo Achilles without any associated risk factors [18]. We present a case of spontaneous bilateral tendoachilles rup- ture in an otherwise healthy 49 year old man which was successfully treated conservatively with two different management protocols. 2. Case Report A 49 year-old man attended fracture clinic with a right TA rupture which was confirmed clinically. He had been on holiday and was walking near a waterfall when he felt pain in his right tendo Achilles area and was unable to walk after that. He had no obvious risk factors for tendon rupture; he was a non-smoker, with no recent or past history of steroid or fluoroquinolone use. He had no me- tabolic derangements, and blood tests (FBC, U+E, LFT, TFT,cholesterol, rheumatoid factor and urate) were all within normal limits. Following a discussion about the relative merits and risks of operative versus non-opera- tive treatment, he opted for non-operative treatment. He had an above knee equinus cast applied with knee flexed about 20 degrees and was asked to be non weight bearing on the right leg. Unfortunately he re-attended casualty 10 days into his course of non-operative treatment complaining of left TA rupture. He was going upstairs using his crutches, when he felt his left TA rupture, which he described as a ‘tear- ing’ sensation. On examination he had bruising; swelling and tenderness of the left TA with a palpable gap present approximately 4 cm proximal to its insertion into os cal- cis. The calf squeeze test was positive, i.e. no ankle plantar flexion was present on squeezing the calf. He was placed into a short-leg (below knee) equinus cast and admitted to the ward while arrangements were put in