# Vertical Fracture of the Medial Malleolus With Concurrent Ipsilateral Achilles Tendon Rupture in a Patient With Progressive Collapsing Foot Deformity: A Rehabilitation Dilemma

## TL;DR

A rare case of a vertical medial malleolus fracture and Achilles tendon rupture in a patient with flatfoot is reported, highlighting the challenges in treatment.

## Contribution

This is the first documented case linking a medial malleolus fracture and Achilles tendon rupture with pes planus.

## Key findings

- The patient was treated with surgical fixation of the fracture and functional rehabilitation for the tendon rupture.
- The case highlights the lack of consensus on optimal management for this rare injury combination.
- The report emphasizes the therapeutic dilemma in treating such complex, concurrent injuries.

## Abstract

A male in his 40s presented with a vertical shear type medial malleolar fracture with an ipsilateral Achilles tendon rupture with a pes planovalgus deformity. Both injuries were diagnosed concurrently on presentation. This is a rare injury pattern with no consensus on optimum management. This is the first case report where pes planus is also described alongside the injuries.

The medial malleolar fracture was successfully treated surgically with an open reduction and internal fixation (ORIF) with antiglide plating. Following ORIF, the patient underwent functional rehabilitation for the Achilles tendon rupture.

The purpose of this case report is to highlight this infrequent injury pattern, which poses a great therapeutic dilemma. The therapeutic considerations regarding surgical and non-surgical approaches to management are thoroughly presented and discussed.