Cholesterol level in non-insertional Achilles tendonopathy

• Familial hypercholesterolaemis is a treatable disorder if diagnosed early.
• Patients with familial hypercholesterolaemia may present early with Achilles tendon pain and it has therefore been suggested that all patients presenting with Achilles tendon pain should have their cholesterol level measured.
• Only 1 out of 83 patients with Achilles tendon pain presenting to an orthopaedic surgeon was found to have a high cholesterol.
• Screening for high cholesterol in patients presenting with Achilles tendon pain to an orthopaedic clinic is not justified.

Familial hypercholesterolaemia is an autosomal dominant disease, with a prevalence of 1 in 500, where lipid deposits occur in the skin, tendons (particularly Achilles tendon) and arteries. It has a high risk of early coronary artery disease and mortality but is treatable with cholesterol lowering strategies if patients are diagnosed early. Studies in patients attending lipid clinics have shown that half the patients may have suffered from Achilles tendon symptoms 20 years earlier and it has been proposed that all patients presenting with Achilles tendon pain should have a serum cholesterol test.All consecutive patients seen in an adult foot and ankle clinic with non-insertional Achilles tendonopathy between April 2012 and March 2014 had their serum cholesterol measured. Only one patient in 83 (p = 0.19) was diagnosed with heterozygous familial hypercholesterolaemia but 3 relatives of the proband patient were also diagnosed by cascade testing.Measurement of cholesterol in all patients presenting with achillodynia does not seem to be justified but the literature suggests that it should probably be considered in patients with bilateral extensive disease or those who give a history of intermittent episodes of severe pain lasting a few days.