PMC6727455_01
X-ray of the left ankle (lateral view) showing the ossified mass in tendo Achilles.
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F1
Taregion (Figs. 1, 2). The magnetic resonance imaging (MRI) confirmed the presence of a bony mass within the substance of TA.
Clinical photograph showing a swelling at the lower calf region, 2 inches above the left ankle.
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F2
Taregion (Figs. 1, 2). The magnetic resonance imaging (MRI) confirmed the presence of a bony mass within the substance of TA.
Ossified mass being excised from the substance of the tendo Achilles.
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F3
TA was split carefully, and bony mass of 3 inches x 2 inches was removed (Figs. 3, 4).
Excised (and bifurcated) bony mass from tendo Achilles.
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F4
TA was split carefully, and bony mass of 3 inches x 2 inches was removed (Figs. 3, 4).
Defect in tendo Achilles, after excision of the ossified mass.
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F5
TA(Fig. 5) was repaired primarily (Fig. 6) using no. 2 Ethibond  (Ethicon), and the wound was closed in layers.
Histology of the lesion showing diffuse ossification (a), within the substance of the tendon (b).
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F7
The histopathology of the excised bony mass (Fig. 7) revealed tendinous tissue showing the exuberant metaplastic bone formation of woven and lamellar types and is laid down as anastomosing thick trabeculae with focal osteoblastic rimming and separated by intertrabecular spaces containing chiefly mature adipose tissue. The trabeculae show evenly distributed osteocytes with lacunar spaces. These histopathological features were suggestive of HOTA.