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Calf muscle evaluation during rehabilitation after flexor hallucis longus tendon transfer in neglected achilles tendon rupture: A case report

Abstract

Introduction: Neglected achilles tendon rupture is generally defined as a rupture with a delay of more than 4 weeks prior to diagnosis or treatment. Difficulties in management make it one of the challenging problems in orthopedic practice. They have a greater tendency to develop complications and slightly poorer functional outcomes than patients with an acute rupture.

Method: This case report features a case of 30 years old female with 3 months of neglected achilles tendon rupture after landing in the wrong position while playing badminton. The patient complains of continuous pain and inability to move her ankle downward, making walking difficult. On physical examination and CT imaging, we found achiles tendon rupture with significant gap and calf muscle atrophy. The patient was then managed operatively by debridement and tendon repair with flexor halucis longus tendon transfer.

Result: Follow up 3 months post-operative, found a difference in calf muscle circumference in both legs. At the same time, there is still an improvement in active ROM ankle plantarflexion and positive single heel raise test on the affected side. The functional outcome measured by ATRS obtained 80 points, and AOFAS ankle-hindfoot scales with a value of 91 points.

Discussion: With several advantages, FHL tendon transfer is the currently used technique for neglected cases of achiles tendon rupture. Despite long immobilization will induce other complications. Good operative techniques and accelerated rehabilitation are still recommended to gain good functional outcomes for the patient.

Section

References

  1. Raghunandan G. Management of Neglected Achilles Tendon Ruptures with Flexor Hallucis Longus Transfer. Journal of Foot and Ankle Surgery (Asia Pacific) 2014;1:5–8.
  2. https://doi.org/10.5005/jp-journals-10040-1002.
  3. Bussewitz BW. Repair of Neglected Achilles Rupture. Clin Podiatr Med Surg 2017;34:263–74. https://doi.org/10.1016/j.cpm.2016.10.012.
  4. Lee KB, Park YH, Yoon TR, Chung JY. Reconstruction of neglected Achilles tendon rupture using the flexor hallucis tendon. Knee Surgery, Sports Traumatology, Arthroscopy 2009;17:316–20. https://doi.org/10.1007/s00167-008-0693-9.
  5. Gil-Melgosa L, Grasa J, Urbiola A, Llombart R, Ruiz MS, Montiel V, et al. Muscular and tendon degeneration after achilles rupture: New insights into future repair strategies. Biomedicines 2022;10. https://doi.org/10.3390/biomedicines10010019.
  6. Cesar Netto C, Chinanuvathana A, Fonseca LF da, Dein EJ, Tan EW, Schon LC. Outcomes of flexor digitorum longus (FDL) tendon transfer in the treatment of Achilles tendon disorders. Foot and Ankle Surgery 2019;25:303–9.
  7. https://doi.org/10.1016/j.fas.2017.12.003.
  8. Chai JH, Bae SW. Evaluation of Calf Muscular Function During the Recovery Phase After the Repair of an Achilles Tendon Rupture. Front Surg 2019;6.
  9. https://doi.org/10.3389/fsurg.2019.00057.
  10. Leppilahti J, Lande S, Forsman K, Kangas J, Kauranen K, Orava S. Relationship Between Calf Muscle Size and Strength after Achilles Rupture Repair. 2000.
  11. Heikkinen J, Lantto I, Piilonen J, Flinkkilä T, Ohtonen P, Siira P, et al. Tendon length, calf muscle atrophy, and strength deficit after acute achilles tendon rupture: Long-term follow-up of patients in a previous study. Journal of Bone and Joint Surgery - American Volume 2017;99:1509–15. https://doi.org/10.2106/JBJS.16.01491.
  12. Lin Y, Yang L, Yin L, Duan X. Surgical Strategy for the Chronic Achilles Tendon Rupture. Biomed Res Int 2016;2016. https://doi.org/10.1155/2016/1416971.
  13. Ravindra H Mahajan, Rakesh B Dala. Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons. Journal of Orthopaedic Surgery 2009;17:194–8.
  14. Coull R, Tr FRCS(, Orth &, Flavin R, Stephens MM, Eng B, et al. Flexor Hallucis Longus Tendon Transfer: Evaluation of Post-operative Morbidity. 2003.
  15. Benitez J, Mansur H, Castro I. Evaluation of the results of flexor hallucis longus tendon transfer for chronic Achilles tendinopathy. Scientific Journal of the Foot & Ankle 2018;12:240–6. https://doi.org/10.30795/scijfootankle.2018.v12.825.
  16. Hahn F, Meyer P, Maiwald C, Zanetti M, Vienne P. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: Clinical outcome and MRI findings. Foot Ankle Int 2008;29:794–802. https://doi.org/10.3113/FAI.2008.0794.
  17. Xu Y, Li C, Xiang F, Deng Y, Lu X. Flexor hallucis longus tendon transfer through a single incision in the treatment of chronic Achilles tendon rupture with large defect 2020. https://doi.org/10.21203/rs.3.rs-17168/v1.
  18. Pertro Spennaccholio, Alberto Vascellari, Davide Cucchi, Gian Luigi Canata, pietro Randelli. Outcome evaluation after Achilles tendon ruptures. A review of the literature. Italy: 2016.
  19. Nordenholm A, Nilsson N, Senorski EH, Helander KN, Westin O, Olsson N. Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment – a case series. J Exp Orthop 2022;9. https://doi.org/10.1186/s40634-022-00451-5.
  20. Möller M, Lind K, Movin T, Karlsson J, Möller M. Calf muscle function after Achilles tendon rupture A prospective, randomised study comparing surgical and non-surgical treatment. J Med Sci Sports 2002;12:9–16.
  21. Bostick GP, Jomha NM, Suchak AA, Beaupré LA. Factors associated with calf muscle endurance recovery 1 year after Achilles tendon rupture repair. Journal of Orthopaedic and Sports Physical Therapy 2010;40:345–51. https://doi.org/10.2519/jospt.2010.3204.
  22. Olsson, N., Karlsson, J., Eriksson, B. I., Brorsson, A., Lundberg, M., & Silbernagel, K. G. Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture. Scandinavian Journal of Medicine & Science in Sports 2012, 24(1),152–158. doi:10.1111/j.1600-0838.2012.01497

How to Cite

Subawa, I. W. ., Pratama, I. P. A. A., & Pramana, I. G. N. B. A. . (2022). Calf muscle evaluation during rehabilitation after flexor hallucis longus tendon transfer in neglected achilles tendon rupture: A case report. Indonesia Journal of Biomedical Science, 16(2), 91–96. https://doi.org/10.15562/ijbs.v16i2.411

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I Wayan Subawa
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I Putu Arya Agung Pratama
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I Gusti Ngurah Bagus Andika Pramana
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