Chronic complete hamstring avulsion causing foot drop - A case report

Hamstring muscle strains are among the most common injuries occurring in athletes. Most often these injuries heal with nonoperative treatment, albeit slowly, and allow the athlete to return to full activity. Complete avulsion of the proximal hamstring tendon is uncommon and difficult to diagnose. Injuries frequently result in severe swelling and ecchymosis of the posterior thigh, making palpation of a defect almost impossible. Brewer3 believed that complete rupture of a hamstring tendon demanded surgical intervention because of the residual loss of power and function in nonoperatively treated cases. Patients with chronic complete hamstring tendon avulsion describe pain, weakness, and cramping, as well as difficulty running, walking, and poor leg control, especially walking downhill. In the literature there are only four reported cases of neurologic involvement with avulsion of the proximal hamstring tendon. In one case, the patient had acute symptoms of sciatica that resolved as swelling of the thigh diminished. In the remaining three cases, patients had symptoms of sciatic paresthesias that in two patients resolved after surgical repair of the rupture and neurolysis. There are no reported cases in the literature of motor nerve dysfunction after avulsion of the hamstring tendons. Here we present the case of delayed onset of foot drop after a chronic complete proximal hamstring tendon avulsion.