Elsevier

The Journal of Foot and Ankle Surgery

Volume 50, Issue 5, September–October 2011, Pages 603-606
The Journal of Foot and Ankle Surgery

Case Reports and Series
Nodular Excision for Painful Localized Achilles Tendon Xanthomas in Type II Hyperlipoproteinemia: A Case Report

https://doi.org/10.1053/j.jfas.2011.04.020Get rights and content

Abstract

Achilles tendon xanthomas are often associated with type II hyperlipoproteinemia, in which low-density lipoprotein derived from the circulation accumulates in the tendons. Sometimes coronary artery disease can jeopardize the life of the patient if the condition is neglected. We describe the case of bilateral painful Achilles tendon xanthomas in a heterozygous type II hyperlipoproteinemia family. Her symptoms were not alleviated despite anti-inflammatory medication and eccentric exercise for 6 months. She was treated with nodular excision of the xanthomas bilaterally and then with postoperative statins to avoid recurrence.

Section snippets

Case Report

A 45-year-old woman was referred with painful nodules in both Achilles tendons that had been observed for 6 months. On physical examination, multiple tender nodules were palpated along her Achilles tendons bilaterally. She was barely able to perform a single or double heel raise posture because of the pain (Fig. 1). The pain was worse during the first few steps in the morning and after rising from chairs, closely resembling the symptoms of usual Achilles tendinitis. No definite masses were

Discussion

Heterozygous FH is an autosomal dominant disorder that causes severe elevations in total cholesterol and LDL. Although moderate hyperlipoproteinemia is a common finding in industrialized countries, heterozygous FH occurs in approximately 1 per 500 persons worldwide (9). Untreated, it is associated with high mortality and morbidity from coronary heart disease. One study reported that about 80% of men with FH develop ischemic heart disease by 50 years of age (11). Achilles tendon xanthomas can

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Cited by (6)

  • Surgical treatment of multiple large tuberous xanthomas in familial hypercholesterolemia: A case report

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    Citation Excerpt :

    Small tuberous xanthomas and tendon xanthomas may regress with medicament or plasma exchange (LDL-C apheresis) after several months to 12 months [7–9]. Surgical excision is indicated for patients with large tuberous xanthomas large without regression after lipid-lowering therapy [7,10]. This paper aims to present a successful surgical treatment for patients with multiple large tuberous xanthomas related to FH.

  • Tendons involvement in congenital metabolic disorders

    2016, Advances in Experimental Medicine and Biology

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Conflict of Interest: None reported.

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