Published: 2019-02-23

Flexor hallucis longus vs. peroneus brevis: the better tendon for augmentation surgery in chronic achilles tendon ruptures

K. V. Nagakiran, Sudeep Madhukar Nambiar, Prasad Soraganvi, Sameer Wooly, H. Balakrishna Gadiyar


Background: Chronic degenerative Achilles tendon ruptures are increasing in incidence. Calcific tendonitis, poor vascularity, prior steroid injections, and proximal migration of tendon render conservative management ineffective. Flexor hallucis longus (FHL) and peroneus brevis (PB) have shown promising results with tendon augmentation procedures. The study was done to find out which was a better tendon for augmentation among the two.

Methods: A total of 27 patients underwent tendon augmentation surgeries using FHL (n=14) and PB (n=13) after randomization at PES Institute of medical sciences and research, Kuppam from March 2014 to December 2018. Both the groups had a standard postoperative regimen and rehabilitative protocol. Functional outcome was assessed using AOFAS, Leppilahti score and ATRS scores.

Results: The functional outcome was comparable in both FHL and PB and there was no clear winner in the study.

Conclusions: Predictably good results are seen with tendon augmentation procedures for Achilles tendon rupture. Both FHL and PB are equally good in providing good plantar flexion power needed in achilles tendon rupture.


Achilles tendon, Achilles tendon rupture, Tendinopathy, Tendon augmentation surgery, Flexor hallucis longus, Peroneus brevis, Patient reported outcome measure

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