Management of Achilles tendinosis using the flexor hallucis longus transfer technique: clinical and functional outcomes

Abstract

Introduction: Achilles tendinopathy is a painful condition that can affect either athletic or not athletic population, but it can also lead to significant morbidity in sedentary patients. Symptoms may be temporally, with an acute onset or even chronic. Chronic symptoms could also be subdivided into insertional and noninsertional according to the compromise of the distal part of the Achilles tendon. The etiology of tendinopathy is multifactorial and has been associated with overuse injury, vascularity disorders, malalignment of the hindfoot and shortening of the gastrocnemius and soleus complex. The aim of this study was to show the results obtained from a prospective cohort of patients who underwent a flexor hallucis tendon transfer for Achilles tendonosis.

Methods: We conducted a case series study from 2006 to 2011, where 26 patients were included with chronic tendonosis treated with FHL transfer at Centro Médico Imbanaco, Cali, Colombia. Follow up on all 26 patients (mean age 53.2 years) is provided with an average follow up 14.5 months. All patients were evaluated postoperatively to assess satisfaction, mobility, plantar flexion strength, and complications. The AOFAS foot ratios for the ankle and hind foot was used. The VAS (visual analogue scale) was used to assess the pain.

Results: Excellent and good results were obtained in 24 of 26 patients (92%) in our study. The AOFAS scale ratings improved from 52.5 (range, 35 to 65) preoperatively to 91.2 (range, 50 to 100) postoperatively (p < 0.001). Pain was improved in 96% of patients. No reintervention was necessary and all but one patient were satisfied with the results obtained.

Discussion: All but one patient evaluated their result as good or excellent in regards to improved function and pain. No patient had significant strength deficit of the hallux after transfer of the FHL tendon.