Achilles Procedures

  • Gregory C. Berlet
  • Roberto A. Brandão
  • Bryan Van Dyke


The surgical treatment of Achilles tendon disorders is integral to the restoration and function of the lower extremity. Achilles tendon pathology is broken down into anatomic areas, insertional and midsubstance, mechanism and timing of injury, acute tears, and chronic pathology.

Acute ruptures of the Achilles tendon, in both elite athletes and “weekend warriors,” remain a common occurrence with an increased incidence in competitive athletes and elderly populations. Chronically attenuated ruptures can be challenging as the muscle undergoes fatty infiltration, thereby decreasing its ability to contract, and in the chronically torn tendon, it can be difficult to re-oppose the proximal and distal segments often times requiring indirect repair or tendon transfers.

Insertional Achilles pathology is a spectrum of problems from tendinitis to tendinosis. Tendinopathy refers to the triad of pain, swelling, and impaired function. Tendinosis occurs because of degenerative processes in the tendon that can be moderated by blood supply, mechanical demand, genetic predisposition, and training errors. The assessment of tendon integrity influences the treatment protocol with tendon transfers being recommend for tendon compromise of over 50%. If the tendon quality is poor, a flexor hallucis longus tendon transfer with or without reattachment of the residual tendon can be performed to restore functional plantar flexion strength.


Achilles rupture Flexor hallucis longus tendon transfer Insertional Achilles tendinosis Midsubstance Achilles tendinosis 



Achilles tendon


Flexor hallucis longus tendon


Insertional Achilles tendinosis


Non-insertional Achilles tendinopathy


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gregory C. Berlet
    • 1
  • Roberto A. Brandão
    • 2
  • Bryan Van Dyke
    • 3
  1. 1.Orthopedic Foot & Ankle CenterWorthingtonUSA
  2. 2.Summit OrthopaedicsIdaho FallsUSA
  3. 3.The Centers for Advanced Orthopaedics, Orthopaedic Associates of Central Maryland DivisionCatonsvilleUSA

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