• C J Lever, H A Bosman, and RobinsonA H NAHNDepartment of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK..
• Wirral University Teaching Hospital, Wirral, UK.
• Bone Joint J. 2018 May 1; 100-B (5): 584-589.

AimsFlexor hallucis longus (FHL) tendon transfer is a well-recognized technique in the treatment of the neglected tendo Achillis (TA) rupture.Patients And MethodsWe report a retrospective review of 20/32 patients who had undergone transtendinous FHL transfer between 2003 and 2011 for chronic TA rupture. Their mean age at the time of surgery was 53 years (22 to 83). The mean time from rupture to surgery was seven months (1 to 36). The mean postoperative follow-up was 73 months (29 to 120). Six patients experienced postoperative wound complications.ResultsThe mean postoperative Achilles tendon Total Rupture Score (ATRS) was 83 (40 to 100) and the mean American Orthopaedic Foot & Ankle Society (AOFAS) score was 94.3 (82 to 100). Tegner scoring showed a mean reduction of one level from the pre-injury level of activity. There was a mean reduction of 24% (4 to 54) in dynamometer-measured strength of ankle plantarflexion, in comparison with the non-operated side. The hallux had a mean of only 40% (2 to 90) strength of plantarflexion in comparison with the contralateral side.ConclusionWe conclude that transtendinous FHL transfer for neglected TA ruptures, with a long harvest to allow reattachment of the triceps surae, provides reliable long-term function and good ankle plantarflexion strength. Despite the loss of strength in hallux plantar flexion, there is little comorbidity from the FHL harvest. Cite this article: Bone Joint J 2018;100-B:584-9.

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