{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:21Z","timestamp":1783509261936,"version":"3.55.0"},"reference-count":18,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Over a time frame of less than 1 year, a 23-year-old competitive horseback rider experienced a midsubstance tear of both the tibialis anterior and extensor hallucis longus tendons without inciting injury. It was after the second spontaneous tear that the patient's recent diagnosis of Lyme disease became the likely culprit. Often, patients with chronic Lyme disease present with an elaborate clinical picture that can mimic many more common diagnoses such as septic arthritis, transient synovitis, ligamentous sprain, and various other traumatic injuries. With the pathognomonic erythema migrans rash reported to be present less than 50% of the time in late-stage infections, the diagnosis of Lyme disease can often be difficult, with a high rate of underdiagnosis. It is important that Lyme disease be included in the differential diagnosis of spontaneous tendon pathology, especially for physicians practicing in highly endemic areas. The treatment is relatively simple and successful\u2014especially for an acute infection\u2014and it is important to initiate treatment promptly to prevent disability.<\/jats:p>","DOI":"10.7547\/17-179","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T10:55:12Z","timestamp":1574420112000},"page":"455-458","source":"Crossref","is-referenced-by-count":2,"title":["Spontaneous Rupture of Multiple Tendons in the Lower Extremity Following the Diagnosis of Lyme Disease"],"prefix":"10.3390","volume":"109","author":[{"given":"Regina","family":"Fiacco","sequence":"first","affiliation":[{"name":"JFK Medical Center, Atlantic, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James T.","family":"Clancy","sequence":"additional","affiliation":[{"name":"JFK Medical Center, Atlantic, FL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-109-6-455-b01","series-title":"MMWR Surveill Summ","first-page":"1","article-title":"Surveillance for Lyme disease\u2014United States, 1992\u20132006","volume":"57","author":"Bacon \n              RM,","year":"2008","unstructured":"Bacon \n              RM, \n            \n            \n              Kugeler \n              KJ, \n            \n            \n              Mead \n              PS, \n            \n            et al: \n          Surveillance for Lyme disease\u2014United States, 1992\u20132006. MMWR Surveill Summ57: 1, 2008.18830214"},{"key":"i8750-7315-109-6-455-b02","article-title":"Lyme disease","year":"2018","unstructured":"Centers for Disease Control and Prevention: Lyme disease. Available at: http:\/\/www.cdc.gov\/lyme\/. Accessed May 1, 2018."},{"key":"i8750-7315-109-6-455-b03","series-title":"Am J Orthop","first-page":"E167","article-title":"Patellar tendon rupture as a manifestation of Lyme disease","volume":"37","author":"Pandya \n              NK,","year":"2008","unstructured":"Pandya \n              NK, \n            \n            \n              Zgonis \n              M, \n            \n            \n              Ahn \n              J, \n            \n            et al: \n          Patellar tendon rupture as a manifestation of Lyme disease. Am J Orthop37: E167, 2008.18982192"},{"key":"i8750-7315-109-6-455-b04","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1056\/NEJM200107123450207","article-title":"Lyme disease","volume":"345","author":"Steere \n              AC:","year":"2001","unstructured":"Steere \n              AC: \n            \n          \n          Lyme disease. N Engl J Med345: 115, 2001.10.1056\/NEJM20010712345020711450660"},{"key":"i8750-7315-109-6-455-b05","series-title":"Curr Opin Rheumatol","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1097\/00002281-199108000-00010","article-title":"Pathogenesis, diagnosis, manifestations, and treatment of Lyme disease","volume":"3","author":"Schoen \n              RT:","year":"1991","unstructured":"Schoen \n              RT: \n            \n          \n          Pathogenesis, diagnosis, manifestations, and treatment of Lyme disease. Curr Opin Rheumatol3: 610, 1991.191105610.1097\/00002281-199108000-00010"},{"key":"i8750-7315-109-6-455-b06","series-title":"Infect Immun","doi-asserted-by":"publisher","first-page":"3929","DOI":"10.1128\/IAI.67.8.3929-3936.1999","article-title":"Plasmin-coated Borrelia burgdorferi degrades soluble and insoluble components of the mammalian extracellular matrix","volume":"67","author":"Coleman \n              JL,","year":"1999","unstructured":"Coleman \n              JL, \n            \n            \n              Roemer \n              EJ, \n            \n            \n              Benach \n              JL: \n            \n          \n          Plasmin-coated Borrelia burgdorferi degrades soluble and insoluble components of the mammalian extracellular matrix. Infect Immun67: 3929, 1999.10.1128\/IAI.67.8.3929-3936.199910417158"},{"key":"i8750-7315-109-6-455-b07","series-title":"Infect Dis Clin North Am","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.idc.2007.12.014","article-title":"Lyme arthritis: pathogenesis, clinical presentation, and management","volume":"22","author":"Puius \n              YA,","year":"2008","unstructured":"Puius \n              YA, \n            \n            \n              Kalish \n              RA: \n            \n          \n          Lyme arthritis: pathogenesis, clinical presentation, and management. Infect Dis Clin North Am22: 289, 2008.1845280210.1016\/j.idc.2007.12.014http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000256176400008&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-109-6-455-b08","series-title":"Arthritis Rheum","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1002\/art.1780310405","article-title":"Spirochetal antigens and lymphoid cell surface markers in Lyme synovitis: comparison with rheumatoid synovium and tonsillar lymphoid tissue","volume":"31","author":"Steere \n              AC,","year":"1988","unstructured":"Steere \n              AC, \n            \n            \n              Duray \n              PH, \n            \n            \n              Butcher \n              EC: \n            \n          \n          Spirochetal antigens and lymphoid cell surface markers in Lyme synovitis: comparison with rheumatoid synovium and tonsillar lymphoid tissue. Arthritis Rheum31: 487, 1988.10.1002\/art.17803104053258751"},{"key":"i8750-7315-109-6-455-b09","series-title":"Med Clin North Am","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S0025-7125(03)00090-7","article-title":"Late and chronic Lyme disease","volume":"86","author":"Donta \n              ST:","year":"2002","unstructured":"Donta \n              ST: \n            \n          \n          Late and chronic Lyme disease. Med Clin North Am86: 341, 2002.10.1016\/S0025-7125(03)00090-711982305"},{"key":"i8750-7315-109-6-455-b10","series-title":"J Am Acad Orthop Surg","doi-asserted-by":"publisher","first-page":"91","DOI":"10.5435\/00124635-201102000-00004","article-title":"Lyme disease and the orthopaedic implications of Lyme arthritis","volume":"19","author":"Smith \n              BG,","year":"2011","unstructured":"Smith \n              BG, \n            \n            \n              Cruz \n              AI\n              Jr, \n            \n            \n              Milewski \n              MD, \n            \n            et al: \n          Lyme disease and the orthopaedic implications of Lyme arthritis. J Am Acad Orthop Surg19: 91, 2011.2129293210.5435\/00124635-201102000-00004http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000287425200004&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-109-6-455-b11","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1053\/j.jfas.2015.06.006","article-title":"Lyme disease manifestations in the foot and ankle: a retrospective case series","volume":"55","author":"Miller \n              JR,","year":"2016","unstructured":"Miller \n              JR, \n            \n            \n              Dunn \n              KW, \n            \n            \n              Braccia \n              D, \n            \n            et al: \n          Lyme disease manifestations in the foot and ankle: a retrospective case series. J Foot Ankle Surg55: 1241, 2016.10.1053\/j.jfas.2015.06.00626190776http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000387094700021&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-109-6-455-b12","series-title":"Open Neurol J","doi-asserted-by":"publisher","first-page":"179","DOI":"10.2174\/1874205X01206010179","article-title":"Damage of collagen and elastic fibres by Borrelia burgdorferi: known and new clinical and histopathological aspects","volume":"6","author":"M\u00fcller \n              KE:","year":"2012","unstructured":"M\u00fcller \n              KE: \n            \n          \n          Damage of collagen and elastic fibres by Borrelia burgdorferi: known and new clinical and histopathological aspects. Open Neurol J6: 179, 2012.10.2174\/1874205X0120601017923986790"},{"key":"i8750-7315-109-6-455-b13","series-title":"FEMS Microbiol Lett","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1111\/j.1574-6968.1996.tb08506.x","article-title":"Borrelia burgdorferi posses a collagenolytic activity","volume":"144","author":"Grab \n              DJ,","year":"1996","unstructured":"Grab \n              DJ, \n            \n            \n              Kennedy \n              R, \n            \n            \n              Philipp \n              MT: \n            \n          \n          Borrelia burgdorferi posses a collagenolytic activity. FEMS Microbiol Lett144: 39, 1996.10.1111\/j.1574-6968.1996.tb08506.x"},{"key":"i8750-7315-109-6-455-b14","series-title":"Infect Immun","doi-asserted-by":"publisher","first-page":"3138","DOI":"10.1128\/IAI.72.6.3138-3146.2004","article-title":"Borrelia burgdorferi binds to, invades and colonizes native type 1 collagen lattices","volume":"72","author":"Zambrano \n              MC,","year":"2004","unstructured":"Zambrano \n              MC, \n            \n            \n              Beklemisheva \n              AA, \n            \n            \n              Bryksin \n              AV, \n            \n            et al: \n          Borrelia burgdorferi binds to, invades and colonizes native type 1 collagen lattices. Infect Immun72: 3138, 2004.1515561510.1128\/IAI.72.6.3138-3146.2004"},{"key":"i8750-7315-109-6-455-b15","series-title":"PLoS One","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0036523","article-title":"DipA, a pore-forming protein in outer membrane of lyme disease Borrelia exhibits specificity for permeation of dicarboxylates","volume":"7:","author":"Thein \n              M,","year":"2012","unstructured":"Thein \n              M, \n            \n            \n              Bonde \n              M, \n            \n            \n              Bunikis \n              I, \n            \n            et al: \n          DipA, a pore-forming protein in outer membrane of lyme disease Borrelia exhibits specificity for permeation of dicarboxylates. PLoS One7:e36523, 2012. Published online May 10, 2012; doi: 10.1371\/journal.pone.0036523."},{"key":"i8750-7315-109-6-455-b16","series-title":"Borreliose","author":"Breves \n              S","year":"2007","unstructured":"Breves \n              S\n            \n          : Borreliose. Colmberg: Medea-Verlag;2007."},{"key":"i8750-7315-109-6-455-b17","series-title":"J Infect Dis","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1093\/infdis\/163.4.895","article-title":"Duration of adult female Ixodes dammini attachment and transmission of Borrelia burgdorferi, with description of a needle aspiration isolation method","volume":"163","author":"Piesman \n              J,","year":"1991","unstructured":"Piesman \n              J, \n            \n            \n              Maupin \n              G, \n            \n            \n              Campos \n              EG, \n            \n            et al: \n          Duration of adult female Ixodes dammini attachment and transmission of Borrelia burgdorferi, with description of a needle aspiration isolation method. J Infect Dis163: 895, 1991.10.1093\/infdis\/163.4.8952010643"},{"key":"i8750-7315-109-6-455-b18","series-title":"J Can Chiropr Assoc","first-page":"269","article-title":"Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy","volume":"55","author":"Miners \n              AL,","year":"2011","unstructured":"Miners \n              AL, \n            \n            \n              Bougie \n              TL: \n            \n          \n          Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. J Can Chiropr Assoc55: 269, 2011.22131563"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/109\/6\/17-179.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/109\/6\/455\/2458367\/17-179.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/109\/6\/17-179.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/109\/6\/17-179.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:17:48Z","timestamp":1783505868000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/109\/6\/455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11]]},"references-count":18,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.7547\/17-179","relation":{},"ISSN":["8750-7315","1930-8264"],"issn-type":[{"value":"8750-7315","type":"print"},{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11]]}}}