Peroneus Longus to Achilles Tendon Transfer

​What are the goals of this procedure?

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-operative treatment may benefit from this transfer.

What signs indicate surgery may be needed?

When flexion 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.

When should I avoid surgery?

If you have significant medical conditions or the soft tissues around your ankle are compromised, you may not be a good candidate for this procedure.

General Details of Procedure

The PL tendon is found, cut and attached either to the Achilles tendon or the heel bone.

Specific Technique

Antibiotics are given before surgery. A tourniquet may be used to control bleeding.  Patients can be placed on their back, side or face down for the surgery. The PL tendon is identified, cut, redirected and tied into either the Achilles tendon or heel bone. To help preserve its function, the lower part may be transferred into the peroneus brevis, which lies next to it. The incisions are then closed and a splint is placed on the leg.

What happens after surgery?

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 discontinued and physical therapy will be started. Recovery may take three to six months. It may take surgical patients a full year before all symptoms resolve.

Potential Complications

There are complications that can occur with any surgery. These include the risks associated with anesthesia, infection, and bleeding or blood clots. Potential complications specific to this procedure include nerve irritation, damage to blood vessels, and rupture or tearing of the transfer.

Frequently Asked Questions

Will loss of PL function lead to long-term foot problems?
The PL causes the first metatarsal bone to bend down. 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 of nerve dysfunction it is unlikely to have the same strength. The PL muscle is not as strong as the gastrocnemius and soleus 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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