Tendon transfer improves ankle function and reduces pain for chronic achilles tendinosis

Jan 24th – Surgical debridement with flexor hallicus longus (FHL) tendon transfer improved achilles tendon function and reduced pain in older, overweight patients.

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Image: PD

1)    Surgical debridement with FHL tendon transfer improved Achilles tendon function and reduced pain in older, overweight patients.

2)    The majority of patients did not experience any instability or loss of function in the great toe following tendon transfer.

For older, overweight patients suffering from chronic achilles tendinosis, surgical debridement with FHL transfer provides excellent functional and pain improvement without compromising hallux strength or balance.  This is the first prospective study to assess outcomes for this procedure in this patient population.

This study is limited by a lack of comparison group.  The advanced age of the study population may also have limited their appreciation of any loss of balance or hallux strength.  In support of this study’s results, significant improvement of pain and function were achieved despite the high age and BMI of the study population.

Click to read in JBJS

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Image: PD

1)    Surgical debridement with FHL tendon transfer improved Achilles tendon function and reduced pain in older, overweight patients.

2)    The majority of patients did not experience any instability or loss of function in the great toe following tendon transfer.

This [prospective] study evaluated 48 limbs in 46 patients who underwent debridement of the Achilles tendon followed by FHL transfer for the treatment of chronic Achilles tendinosis.  Subjects had a mean age of 54 years and a mean body mass index of 33.8.  Functional and pain outcomes were assessed at 0, 3, 6, 12, and 24 months using the visual analogue scale(VAS), SF-36, and Ankle Osteoarthritis Scale(AOS).  Hallux weakness and balance were also assessed at all time-points.

Improvements in functional outcomes were shown in the SF-36 physical score (34.3 pre vs 49.0 post, p < 0.001) as well as the single-leg heel rise component of the AOS (1.9cm vs 7.3cm, p < 0.001).  Dysfunction concurrently decreased as measured by the dysfunction component of the AOS (62.6 vs 11.0, p < 0.001).  Pain was shown to decrease both on the VAS (6.7 vs 2.0, p < 0.001) and the AOS pain subscore (54.4 vs 1.9, p < 0.001).  Additionally, 57% of patients reported no hallux weakness and 76% reported no imbalance due to hallux weakness.

Further reading:

1. Surgical Treatment for Chronic Disease and Disorders of the Achilles Tendon
2. Achilles Tendinopathy

In sum: For older, overweight patients suffering from chronic achilles tendinosis, surgical debridement with FHL transfer provides excellent functional and pain improvement without compromising hallux strength or balance.  This is the first prospective study to assess outcomes for this procedure in this patient population.

This study is limited by a lack of comparison group.  The advanced age of the study population may also have limited their appreciation of any loss of balance or hallux strength.  In support of this study’s results, significant improvement of pain and function were achieved despite the high age and BMI of the study population.

Click to read in JBJS

By [CC] and [AO]

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Chaz Carrier: Chaz is a 2nd year M.D. candidate at Albany Medical College.

Allen Ho: Allen is a 4th year M.D. candidate at Harvard Medical School.

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