What Is a Peroneus Longus to Achilles Tendon Transfer?
A peroneus longus (PL) to Achilles tendon transfer is done to restore strength across the ankle joint. Strength may have been lost due to an injury to the Achilles tendon or a neurological disorder. Also, patients with Achilles tendon pain that has not improved from non-surgical treatment may benefit from this transfer. Other tendons (such as the tendon to the big toe or lesser toes) may be chosen for the transfer instead of the PL, based on the underlying anatomy and function.
When push-off strength has been lost, a tendon transfer can be a very helpful way to improve function to the foot and ankle. In cases where the PL muscle is overactive or other muscles are not available for transfer, the PL may be used. Transfer of the PL muscle may help reduce pain and restore blood flow to an injured Achilles.
If you have significant medical conditions, poor circulation, or the soft tissues around your ankle are compromised, you may not be a good candidate for this procedure. If you smoke, you should try to quit before proceeding with this surgery.
This procedure is typically done on an outpatient basis, meaning the patient can go home the same day. Antibiotics are given before surgery. A tourniquet may be used. Patients can be placed on their back, side, or face down for the surgery depending on surgeon’s preference and any additional procedures being performed. The PL tendon is identified, cut, redirected and tied into either the Achilles’ tendon with suture or into heel bone with an anchor. The incisions are then closed and a splint is placed on the leg.
After surgery, no weight is placed on the leg for a period of time. A cast boot will be used at some point to protect the transfer while allowing removal for therapy and hygiene. After a few months the boot will be removed and physical therapy will start. Recovery may take three to six months. It may take surgical patients a full year before all symptoms resolve.
Risks and Complications
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Potential complications specific to this procedure include nerve irritation, damage to blood vessels, and rupture or tearing of the transferred tendon.
Will loss of PL function lead to long-term foot problems?
The PL causes the first metatarsal bone in the foot to bend down, increasing the arch. Loss of its function is more important in situations such as flatfoot deformity where it functions as a supportive structure. In other situations loss of this tendon should not cause any long-term problems.
Will my ankle be as strong as it was before I had the problem with my Achilles tendon?
If the calf muscles are still functional and the PL tendon is used to help reconnect them to the heel, then the transfer may restore close to normal strength. In cases where the transfer is performed for nerve dysfunction, the strength typically is improved though it is unlikely to be normal. The PL muscle is not as strong as the calf muscles that act on the Achilles tendon. The muscle serves to provide some power that was lost and will get stronger with use, but it will never reach the strength of these other muscles.
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