Peroneus Longus to Achilles Transfer

Edited by Kenneth Hunt, MD


In patients with a chronic Achilles rupture, the Peroneus Longus (PL) tendon may be used to reinforce or even replace the Achilles tendon. This procedure may also be indicated if the Achilles has been lost through deep infection or through severe or repeated injury requiring its removal. This procedure has a similar goal as the Flexor Hallucis Longus (FHL) transfer to the Achilles tendon, but uses the peroneus longus muscle tendon unit rather than the FHL. A (PL) to Achilles tendon transfer is done to restore plantarflexion strength across the ankle joint and reduce pain associated with a chronically injured or degenerated Achilles tendon.


The peroneus longus tendon runs on the outside of the lower leg, behind the outside of the ankle joint. The procedure typically involves an incision to harvest the tendon on the outside of the mid foot, where the tendon wraps around to the bottom of foot. It is released at the bottom of the foot to maximize the length of the tendon for transfer. A second incision may then be used on the outside back of the lower leg, where the Achilles can also be accessed, to find the PL tendon and muscle belly in the back of the ankle and free it up. The tendon is then pulled into the back of the lower leg incision It is then attached into the far (distal) stump of the Achilles and/or into the heel bone (calcaneus) through that same incision, or through a third incision made on the outside of the heel if needed. The transferred PL tendon is placed to an appropriate tension to give the best amount of tissue and strength, and attached through drill holes with suture, or to the bone with interference screws.


Recovery requires the transferred peroneus longus tendon to heal solidly. For this reason, patients are usually kept non-weight bearing for a minimum of six weeks, to allow the tendon transfer to scar in, heal, and consolidate. At that point, patients can begin gradually increasing their activity level. A physical therapy program working on recovering range of motion, strengthening, retraining this muscle, and restoring normal gait, is usually started at this time. It is usually many months or even more than a year before the patient has reached their maximal recovery.


General Complications

Complications, although unlikely, may include:

Specific Complications

Potential complications that are specific to the Peroneus Longus to Achilles transfer include:
  • Sural nerve injury. The sural nerve runs close to both incisions. It may be injured either directly or from scar formation. An injury to the sural nerve may lead to numbness or a burning sensation over the outside of the foot.
  • Failure of the tendon transfer. In some instances, the tendon transfer does not take and therefore does not function normally.  For the tendon transfer to work, it must heal to the tendon or bone solidly enough to withstand the force that it generates.


Edited December 8, 2015


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