# Affordable approach using flexor hallucis longus muscle graft for chronic Achilles tendon rupture: A case report

## TL;DR

A low-cost surgical method using the FHL tendon graft effectively repairs chronic Achilles tendon ruptures, especially in remote hospitals.

## Contribution

The study presents a cost-effective surgical approach using the FHL tendon graft for chronic Achilles tendon rupture.

## Key findings

- FHL tendon grafting is an affordable and effective treatment for chronic Achilles tendon rupture.
- The technique is particularly suitable for use in remote area hospitals.
- FADI and VAS are useful tools for evaluating post-surgery outcomes.

## Abstract

The Achilles tendon is vital in maintaining balance when walking. An affordable approach using the flexor hallucis longus (FHL) tendon graft is a cost-effective treatment.

A 35-year-old male who worked as a porter was taken to the clinic after falling while going downstairs a year ago. The physical examination showed gastrocnemius muscle atrophy and limited range of motion (ROM). The Thompson test was performed, and the result was positive for the Achilles tendon rupture (ATR).

Various techniques could be used in a chronic Achilles case, including autograft and allograft. Because the gap was 5.5 cm, we implemented a suitable surgical approach using an FHL tendon graft to repair a chronic ATR. The Euroqol 5-Dimension (EQ5D), the Visual Analog Scale (VAS), the Foot and Ankle Disability Index (FADI), and the cost-effectiveness (CEA) were measured to follow up patients' outcomes.

A grafting procedure using the FHL tendon was affordable and cost-effective for reconstructing a chronic ATR. This technique was preferable, especially in remote area hospitals.

•A chronic Achilles tendon rupture should be repaired to improve patient's quality of life.•FHL muscle grafting is cost-effective procedure.•A grafting approach using FHL muscle is more applicable in remote area hospital.•Foot and Ankle Disability Index (FADI) and Visual Analog Scale (VAS) can be used to evaluate the outcome.

A chronic Achilles tendon rupture should be repaired to improve patient's quality of life.

FHL muscle grafting is cost-effective procedure.

A grafting approach using FHL muscle is more applicable in remote area hospital.

Foot and Ankle Disability Index (FADI) and Visual Analog Scale (VAS) can be used to evaluate the outcome.