A Rare & Complex Achilles Tendon Reconstruction Restoring Mobility

At Aadhar Health Institute, we take pride in managing complex and challenging cases that require advanced surgical expertise, detailed planning, and an unwavering commitment to patient recovery. This month, we present an extraordinary case that truly reflects the skill and excellence of our Orthopaedic Surgery team.

1

A Challenging Presentation

A 50-year-old active female patient presented with sudden difficulty in walking without support. Just days earlier, she had received a local steroid injection for heel pain at another facility. Soon after, she developed severe weakness, pain, and functional loss.

Clinical examination and imaging revealed a massive degenerative Achilles tendon tear, likely triggered by the steroid injection. Such degenerative tears are rare and far more complex than routine ruptures because the tendon becomes weak, fragmented, and unfit for direct repair.

A Rare 11 cm Achilles Tendon Defect

Intraoperative findings showed an extensive 11-cm tendon defect—far beyond the range where normal stitching can restore function. Injuries with such large gaps are uncommon and demand advanced reconstructive strategies to restore biomechanics and long-term function.

A Complex Reconstruction: Tongue Turn-Down Flap + FHL Tendon Transfer

To reconstruct the tendon and restore strength, a Tongue Turn-Down Achilles Tendon Flap was performed. This technique involves fashioning a strong flap from the healthy part of the tendon and rotating it downward to bridge the gap.

However, due to the enormous defect and poor distal tendon quality, reinforcement was necessary. The surgical team performed a Flexor Hallucis Longus (FHL) Tendon Transfer, one of the most reliable procedures for massive Achilles injuries.

The FHL tendon offers:

  • Excellent blood supply
  • Strong mechanical strength
  • A natural line of pull similar to the Achilles
  • Improved long-term endurance and functional stability

This combined approach ensured both gap bridging and enhanced long-term durability, crucial for the patient’s active lifestyle.

Surgical Precision at Its Best

This reconstruction required:

  • Detailed preoperative planning
  • Precise anatomical dissection
  • Expert flap design
  • Advanced tendon transfer skills
  • Meticulous suturing for optimal tendon tension and alignment

Every step was executed with exceptional precision to restore proper gait mechanics and ensure the best possible outcome.

Outcome

The patient is recovering well with restored tendon continuity, improved strength, and a significantly enhanced quality of life. This case stands as a testament to the advanced surgical capabilities and patient-centric care at Aadhar Health Institute.