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A misdiagnosed fracture of the calcaneum
  1. D P S Baghla,
  2. N Somashekar
  1. St Mary's Hospital, Praed Street, Paddington, London W2 1NY, UK
  1. Correspondence to:
 Mr D P S Baghla; 
 paul{at}baghla.freeserve.co.uk

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I am writing in response to the interesting case report of “A misdiagnosed fracture of the calcaneum”.1 The author, having accepted the original diagnosis of partial Achilles tendon rupture was incorrect, suggested on expanding the criteria for radiological assessment in doubtful clinical cases. It was obvious from the history that the injury was sustained as a result of minimal trauma, in a patient with significant risk factors for osteoporosis. Coupled with an examination finding of a palpable gap in the Achilles tendon/calcaneal complex, the incorrect diagnosis was made solely on a negative Simmonds test. With these clinical findings and the published lateral radiograph of the calcaneum, I do not accept the original opinion of a negative Simmonds test. Simmonds 2 or similarly Thompson's test,3 has been shown to be a reliable sign for complete Achilles disruption,4 with a diagnosis of partial rupture being a rare occurrence!

The lesson to be learnt from this case is not how to increase our diagnostic accuracy with radiology, but the importance of taking a good history and performing a sound clinical examination. The last thing we need is to generate protocols and criteria to make up for our shortcomings. Please note the correct spelling for Simmonds!

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