13-year-old with left heel injury.

CASE PRESENTATION

A 13‐year‐old female presented to a pediatric emergency department after the back of her left heel was struck with a sharp metal object. She had a 1.5 cm horizontal laceration with protrusion of tissue 2 cm from the calcaneus.

Informed consent was obtained from the responsible party.

DIAGNOSIS

Traumatic Achilles Tendon Laceration

Point‐of‐care ultrasound (POCUS) showed a complete disruption of the left Achilles tendon (AT) with loss of fibrillar appearance (Figure 1). The unaffected right side was scanned for comparison (Figure 2). Distally, the tendon was retracted with surrounding fluid suggestive of inflammation (Figure 3). Dynamic Thompson testing with POCUS showed no tendon movement.

FIGURE 1

Long‐axis view of affected Achilles tendon

FIGURE 2

Long‐axis view of the unaffected Achilles tendon

FIGURE 3

Short‐axis view of affected Achilles tendon

Magnetic resonance imaging (MRI) revealed a laceration of the AT with retraction of the proximal stump. The patient was diagnosed with a full AT laceration, splinted, and discharged with outpatient follow‐up for surgical repair.

Literature on AT lacerations is sparse, particularly in the pediatric population. , Other AT injuries, such as AT ruptures, commonly are seen in middle‐aged men involved in sports with an incidence of roughly 18 per 100,000 people. In contrast, AT lacerations most commonly are caused by bicycle spoke injuries , non‐lethal weapons , and lawn mowers. , Physical exams for AT injuries often are limited because of pain or swelling; acute AT injuries can be missed in as many as 20% of cases. Ultrasound has a comparable sensitivity and specificity to MRI and is a viable alternative for pediatric patients in the ED.

To our knowledge, this is the first case report of POCUS diagnosing an acute AT laceration in the pediatric population. The addition of POCUS to routine care can lead to improved accuracy in acute AT laceration diagnosis, timely management, and appropriate referrals.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Supporting material

Click here for additional data file.