Achilles Tendon Xanthomas

A 51-year-old woman complained of mild pain in the Achilles tendon area of both feet. This was aggravated when she stood for prolonged periods and when she wore tight, high-heeled shoes. Physical examination results were unremarkable except for a disputable palpable thickness of the Achilles tendons, especially on the right foot.

Ultrasonography revealed hypoechoic infiltration of the right tendon (crosses). Routine laboratory tests indicated severe hypercholesterolemia: serum levels of total cholesterol, 440 mg/dL; triglycerides, 120 mg/dL; and high-density lipoprotein cholesterol, 44 mg/dL. The patient's two sons, aged 21 and 26, and her mother, aged 69, also proved to have elevated serum cholesterol values. The patient's severe hypercholesterolemia, the strong family history, and the Achilles tendon lesions (compatible with tendinous xanthomas) confirmed the diagnosis of familial hypercholesterolemia.

Drs Haralampos Milionis, Nicholas Katsarakis, and Moses Elisaf of Ioannina, Greece, thus conclude that the determination of serum cholesterol levels has value for patients with symptoms related to the Achilles tendon. Careful physical examination and ultrasonographic imaging of the tendons are also of paramount importance in assessing lesions in this area.