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A Journal on Sports Medicine

Official Journal of the Italian Sports Medicine Federation
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Medicina dello Sport 2014 June;67(2):309-21

language: English, Italian

Long-haul flight-associated sudden-onset mid-portion Achilles tendinopathy in a veteran judo athlete: a case report

De Crée C. 1, 2

1 Department of Medicine and Surgery, University of Rome “Tor Vergata”, Rome, Italy;
2 International Association of Judo Researchers, UK


Venous stasis caused by environmental and mechanical conditions associated with cramped seating positions during economy class air travel may lead to Deep Venous Thrombosis. In the present case report we describe for the first time how similar circumstances, however, led to a distinctive medical condition. A 44-year-old male former elite judo athlete of African-American ethnicity, who de-boarded a passenger aircraft in Tokyo, after a 10-hour nonstop intercontinental flight while seated in economy class, complained of stiffness, pain and a palpable bulge in the mid-portion of his left Achilles tendon. Since taking up a new job three years earlier, he had suffered severe chronic lack of sleep, adopted significant dietary changes (increase in high-carbohydrate food), and developed obesitas athletica and insulin resistance. He had, however, no history of prior Achilles tendon injuries. Color Doppler ultrasound and clinical findings were consistent with sudden-onset chronic mid-portion Achilles peritendinitis. Differential diagnosis included: Achilles tendinosis, ankle posterior impingement syndrome, malalignment, tibialis posterior tendinitis, venous thromboembolism and xantoma. The subject’s anthropometric and metabolic conditions made the injury highly resistant to icing and topical or oral medication. A conservative approach supported by a years-long program of exercise, weight loss, eccentric tendon loading and reduction of dietary carbohydrate contents finally was able to resolve the condition. The economy class syndrome as previously described has not included sudden-onset Achilles tendinopathy; neither is severe sleep deprivation typically associated with tendinopathies. Lower-leg medical problems associated with long-haul air travel in cramped economy class seating may include sudden-onset tendinopathies if the subject has an underlying pro-inflammatory metabolic environment such as sleep deprivation, insulin resistance or type-2 diabetes. Effective treatment strategies of such tendinopathies will therefore also require correction of the overall metabolically hostile environment.

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