Functional Outcomes of Flexor Hallucis Longus Tendon Transfer after Excision of Achilles Tendon Xanthoma: A Case Series
Keywords:
Achilles tendon xanthoma; Flexor hallucis longus tendon transfer; Achilles tendon reconstruction; Functional outcome; Ankle functionAbstract
Background Achilles tendon xanthoma is an uncommon manifestation of lipid metabolism disorders that may lead to progressive tendon enlargement, painless functional impairment and tendon defects after excision. This study evaluated the functional outcome of flexor hallucis longus (FHL) tendon transfer following surgical excision of a symptomatic Achilles tendon Xanthoma. Methods This single-center prospective observational case series comprised eight consecutive patients who underwent surgical excision of Achilles tendon xanthoma followed by FHL tendon transfer at the Department of Orthopaedic Surgery, Bangladesh Medical University (BMU), Dhaka, Bangladesh, between July 2024 and June 2026. Functional status was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and pain was assessed using the Visual Analog Scale (VAS). Ankle dorsiflexion and plantarflexion were recorded preoperatively and postoperatively at 3 months, 6 months, up to final follow-up. Postoperative complications were documented. Changes across follow-up assessments were analysed using the Friedman test. Results The mean age was 31.6 ± 6.8 years, and 5 (62.5%) patients were female. Bilateral involvement was observed in 6 (75.0%) patients and dyslipidaemia/hypercholesterolaemia was present in 5 (62.5%). The mean AOFAS score improved from 51.8 ± 8.7 preoperatively to 89.1 ± 5.4 at final follow-up (p = 0.012), while VAS pain scores decreased from 7.0 ± 1.1 to 1.6 ± 0.7 (p = 0.011). Dorsiflexion and plantarflexion also improved significantly (p = 0.018 and p = 0.012, respectively). Seroma, superficial wound infection, delayed wound healing, and persistent plantarflexion weakness occurred in 1 (12.5%) patient each. No tendon re-rupture or revision surgery occurred. Conclusion FHL tendon transfer following excision of Achilles tendon xanthoma was associated with favourable functional outcomes and improved ankle range of motion in this case series. No tendon re-rupture or revision surgery was observed during follow-up.
Bangladesh Journal of Medical Science Vol. 25 No. 04 October’26 Page: 1346-1353
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Copyright (c) 2026 Md Ehteshamul Choudhury, Khandker Md Nurul Arifeen, A Z M Selimullah, Abu Zaffar Chowdhury, Md Ali Faisal, Chowdhury Iqbal Mahmud, Madhu Sudan Paul, Lubna Ferdous, Pawan Rawal
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