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

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.