Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer

From July 2000 to July 2012, we have treated 48 cases with neglected Achilles tendon ruptures in Government General Hospital, Kurnool, India, with modified flexor hallucis longus (FHL) transfer. Thirty-three patients had achillodynia and 29 had local steroid infiltration. Thirty-six patients presented with ruptures in hypovascular zone II and, in 31, repair was after 3 weeks, graded as late (Inglis). The patients were managed based on a standardized evaluation and surgical protocol. The technique of FHL transfer was simplified by anchoring the tendon in a vertical transcalcaneal tunnel. The results were evaluated by Quigley’s method, 100 point scoring system of Leppilahti, and recently updated with AOFAS hind foot score. The follow-up ranged from 2.5 to 12.2 years. The follow-up suggested that patients with FHL transfer showed significantly lower mean wound healing times and weight-bearing time and functional recovery times when compared with patients who had peroneal transfer, for neglected ruptures. The results are presented, analyzed and discussed.