Unilateral leg oedema due to spontaneous Achilles tendon rupture

This is a case of severe unilateral lower leg oedema in a 77-year-old man, due to a spontaneous, complete Achilles tendon rupture. What makes this case unusual is the absence of trauma in the patient’s history. The correct diagnosis was made only after magnetic resonance imaging. However, a thorough clinical re-examination of the patient revealed an inability to stand and walk on toes and a palpable defect of the Achilles tendon, which was difficult to detect due to the marked oedema. This case reminds physicians that an Achilles tendon rupture can also occur without clear history of trauma and should be considered as a cause of unilateral lower leg oedema, especially in presence of pain. Moreover, it illustrates the crucial role of a thorough clinical examination (including standing and walking on toes) for the correct diagnosis, even when restricting factors such as oedema and pain are present.