The peroneus longus (PL) is a muscle that starts on the outer bone of the lower leg and becomes a tendon above the ankle in order to attach the muscle to the foot. The goal of a peroneus longus to Achilles tendon transfer is to restore strength across the ankle joint. This strength may have been lost due to an injury to the Achilles tendon or a neurological disorder. Patients with Achilles tendon pain that has not improved with non-surgical treatment also 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.
If you have lost push-off strength, your foot and ankle orthopaedic surgeon may recommend a tendon transfer to improve the function of your 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 you can go home the same day. You will be given antibiotics before surgery. You may be placed on your back, side, or face down for the surgery depending on your surgeon's preference and any additional procedures being performed. Your surgeon will identify, cut, and redirect the PL tendon, and then tie it into either the Achilles’ tendon with suture or into the heel bone with an anchor. The incisions are then closed and
a splint is placed on the leg.
After surgery, you will need to keep weight off your leg for a period of time. A cast or boot will be used 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 3-6 months. It may take a full year for all symptoms to resolve.
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 (tearing) of the transferred tendon.
In most situations, loss of the PL tendon should not cause any long-term problems. If you have flatfoot deformity or another condition where the PL functions as a supportive structure, you should talk to your foot and ankle orthopaedic surgeon before proceeding with this surgery.
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.
Original article by Scott Holthusen, MD
Contributors/Reviewers: Jeffrey Feinblatt, MD
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