Krackows Technique Used to Repair for Two Month Old Bilateral Tendoachilles Rupture after Local Steroid Infiltration: Rare Case Report.

The causes for the painful heel around the Achilles tendon are Achilles tendinitis and retrocalcaneal bursitis. The treatment modalities range from simple NSAID’s, hot water fomentation, ultrasound phonophoresis, and intralesional steroids to surgery. There is a debate on giving intralesional steroids in and around the Achilles tendon. Most common complication of intralesional corticosteroids injection is rupture of the tendon. Here is a case of bilateral tendoachilles rupture due to intralesional corticosteroid infiltration. A 32 year old male suffering from bilateral retro calcaneal bursitis since two year was treated with two doses of intralesional steroid for left tendo-Achilles tendinitis 2 month apart and one dose intra lesional corticosteroid around tendoachilles on right Achilles tendon after 2 month of first dose of left side three months prior to rupture. Two months back patient had rupture of bilateral tendoachilles. This was confirmed by ultrasound and MRI examination. We treated the rupture using Krackow’s technique to repair the tendon. Follow up at one year revealed good functional outcome. Bilateral tendoachilles rupture due to corticosteroid infiltration is very rare. Better to avoid intralesional steroid injections in and around the tendoachilles. MRI and ultrasound are confirmatory. MRI is more sensitive than ultrasound, but due to cost USG is the preferred investigation. Histopathological investigation reveals the tendon end to be degenerated; thereby chronic ruptures should be repaired surgically, which reduces chance of failure and improves functional outcome. In our case is operated in one step.