Procedure
Achilles Debridement & FHL Transfer
For Non-Insertional Achilles Tendinopathy
What It Involves
For non-insertional Achilles tendinopathy, surgery involves removing the diseased, painful portion of tendon tissue and, where degeneration is more significant, augmenting healing with a myotendinous FHL transfer. The degenerate portion of the tendon is identified and excised — for milder disease with a structurally intact tendon, debridement alone may be sufficient.
Where a transfer is added, the healthy muscle belly of the flexor hallucis longus (FHL), at the myotendinous junction higher in the calf, is mobilised and sutured onto the anterior surface of the debrided Achilles tendon. This is not a structural reconstruction — the FHL tendon itself is not detached or anchored into bone — so big toe flexion strength is generally well preserved. Bringing this well-vascularised muscle tissue directly against the diseased area improves blood flow and supports healing. The procedure is performed under general or regional anaesthesia, typically taking 45–90 minutes.
Recovery Timeline
Everyone heals at a different rate — this timeline is a guide.
Weeks 1–2
An equinus cast holds the ankle in a slightly plantarflexed position to protect the muscle transfer and settle initial swelling. The wound is checked and sutures removed at 2 weeks.
Weeks 2–6
Transition into a boot, with the ankle brought back to neutral progressively — one wedge removed per week — so that you are plantigrade by 6 weeks. Weight-bearing progresses in the boot over this period.
6–8 weeks
Transition into supportive footwear, with physiotherapy commencing for graduated Achilles loading and calf strengthening. Most patients return to low-impact activity by this stage.
3–4 months
Running and higher-impact activity are reintroduced gradually, guided by symptoms and physiotherapy progress, with a final review and discharge at this stage.