Management of Chronic Insertional Achilles Tendinopathy Using Flexor Hallucis Longus Tendon Transfer in Patients Over 50 Years of Age: A Four-Case Series Following the CARE Guidelines

Abstract

Introduction. Chronic insertional Achilles tendinopathy is a debilitating condition, particularly in patients over 50 years of age, due to progressive degenerative changes. When conservative management fails, transfer of the flexor hallucis longus (FHL)  tendon has emerged as a reliable surgical option. This study aimed to describe the surgical technique and present clinical outcomes in four patients, in accordance with the CARE guidelines.

Results. Four female patients (51–71 years) with chronic insertional Achilles tendinopathy unresponsive to conservative treatment underwent calcification resection, distal Achilles tendon reinsertion, and FHL transfer. At 12 months, all patients showed marked clinical improvement, with pain resolution, restored plantarflexion, and significant gains in AOFAS (American Orthopaedic Foot and Ankle Society) scores.

Conclusion. FHL tendon transfer for chronic insertional Achilles tendinopathy in patients over 50 provides excellent functional recovery, substantial pain relief, and demonstrates a favorable safety profile with no major complications.