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Strained achilles tendon complicated by nocturnal dyspepsia probably caused by ibuprofen: a case report


A 56-year-old male who is overweight experienced pain in his Achilles tendon after running four miles. He subsequently developed a severe limp. The condition was complicated by nocturnal dyspepsia probably caused by ibuprofen. His pain and limp were gone in six days.

Case presentation

When staying in hotels I often try to take a run in the morning – because, otherwise, I find that I often get no exercise. At the end of March 2008 I was visiting the National Heart Lung and Blood Institute at Bethesda, a suburb of Washington. On the morning after my arrival I ran about a mile and a half through backstreets. I felt good.

Forty years ago, when I was 16 and at school, I was a moderately successful cross country runner. I several times won our school race, and one year I was the South London Grammar School's intermediate champion. I ran cross-country at university but was much less successful – partly because the competition was more intense and partly because I never trained. In my late 20s I ran occasionally for a club but ceased running competitively by the time I was 30, although I did run the Bath half marathon – in 1 hour 45 minutes – about 15 years ago, when I was in my early 40s. Since then I've run a few miles a couple of months but have continued to cycle regularly – about 25 miles a week.

My second morning in Bethesda I took the advice of a colleague and set off to run round the perimeter of the campus of the National Institutes of Health. This turned out to be rather farther than I expected – about four miles – and to be fairly hilly and to be mostly on road. I didn't run uninterruptedly but stopped a few times. It took me about 35 minutes to complete the run, and I was wearing trainers.

At the end of the run I showered and felt fine. I had a light breakfast, worked in my room, and then took a taxi to Dulles Airport, where I caught a plane to San Diego, a five-hour flight, which I flew in a cramped seat in economy class with somebody beside me. From San Diego Airport I took a taxi about 20 miles to the Northern end of San Diego, where I stayed in a hotel so upscale that I felt intimidated. I arrived in the hotel just after 7 San Diego time, took a stroll of about half a mile with some mild discomfort in my left Achilles heel, ate dinner in my room with a half bottle of wine, and went to bed.

During the night I was woken several times by growing discomfort in my left Achilles heel. I tossed and turned in bed and found it difficult to get comfortable. I did, however, keep returning to sleep.

When I woke in the morning and got out of bed I had considerable discomfort. Indeed, I walked with a very pronounced limp. I hobbled, no other word for it, to breakfast. Walking down the stairs was especially difficult. I contemplated going backwards. My discomfort and Long John Silver limp lasted all day, making me feel moderately ridiculous. I didn't walk any great distance, and the limp was more pronounced than the discomfort.

I didn't take any painkillers during the day, but as it came time to bed I decided I ought to. I'd finished the aspirin I usually carry with me, so I went to the hotel shop. It had only ibuprofen, which I have rarely, if ever, taken before. I took one pill before going to bed – after my dinner, which did include probably three glasses of wine.

During the night I woke with pronounced dyspepsia – which I rarely, if ever, get. I wondered what might have caused it, and after running though a sleepy differential diagnosis I decided it was probably the ibuprofen. I was probably right, as the dyspepsia had gone by the morning. I didn't take anymore ibuprofen and it didn't reappear.

My discomfort and limp were both considerably better on the second day, and by the fourth day I'd stopped limping. I didn't go for another run and flew back to London on the sixth day with only a twinge in my Achilles tendon.

This is now two months ago, and I've been for several runs (but of not more than two miles) and walked the Dalesway with a venture to the highest of the Howgills in the middle (90 miles with a 22 mile walk one day). I've had no recurrence of my problem, but I'm still conscious of twinges. I fear that if I try another longish run it might recur. One day I'll experiment and report back.


Written informed consent was not sought for publication of this case report since the author is the subject.

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Correspondence to Richard Smith.

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I am the Editor-in-Chief of Cases Journal. I declare no other competing interests.

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Smith, R. Strained achilles tendon complicated by nocturnal dyspepsia probably caused by ibuprofen: a case report. Cases Journal 1, 31 (2008).

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