# Flexor Hallucis Longus Transfer With Concurrent Gastrocnemius Augmentation in Neglected Tendoachilles Tears: A Case Series

## TL;DR

This case series explores a surgical treatment for neglected Achilles tendon ruptures using a combination of tendon transfer and muscle augmentation, showing significant improvement in patients.

## Contribution

The study introduces a combined surgical approach for neglected Achilles tendon tears using FHL transfer and gastrocnemius augmentation.

## Key findings

- Three patients with neglected Achilles tendon ruptures showed significant clinical improvement after surgery.
- AOFAS scores improved from an average of 35 to 85, and VAS pain scores decreased from 8 to 2 at six months.
- The procedure is presented as an effective treatment for large Achilles tendon defects.

## Abstract

The Achilles tendon, the body's largest tendon, is often vulnerable to rupture, primarily as a result of sudden dorsiflexion of a plantar-flexed foot. This injury predominantly affects individuals in their youth and middle age. In this case series, we describe three middle-aged men with neglected insertional Achilles tendon ruptures, each presenting an average 10 cm defect. They underwent a surgical procedure involving flexor hallucis longus (FHL) tendon transfer with concurrent gastrocnemius augmentation. The FHL tendon was repositioned proximally and securely tenodesed to the proximal stump of the excised Achilles tendon. Following this intervention, substantial clinical improvements were observed at the six-month follow-up, with the American Orthopaedic Foot and Ankle Society (AOFAS) score improving from 35 to 85 and the Visual Analog Scale (VAS) pain score decreasing from 8 to 2. These results highlight the efficacy of flexor hallucis longus tendon transfer with gastrocnemius augmentation as a superior treatment option for neglected insertional achilles tendon tears characterized by substantial defects, promising improved functional outcomes and pain relief.