Lateral Flexor Digitorum Longus Transfer for Peroneal Tendinopathy

Abstract

Category:SportsIntroduction/Purpose:Flexor digitorum longus (FDL) transfer to the lateral foot for concomitant irreparable rupture of the peroneal tendons has been reported in few clinical series. The purpose of this study is to provide midterm outcomes including subjective outcome scores, clinical examination data, and objective power after single-stage FDL tendon transfer.Methods:Twenty-five consecutive patients over a 7 year period (2008-2015) underwent FDL to fifth metatarsal transfer for irreparable peroneal tendon tears. Fifteen patients with a mean follow-up of 53.7 months completed the pain visual analog score (VAS), Foot Function Index (FFI), Short Musculoskeletal Functional Assessment (SMFA), and Foot and Ankle Ability Measure (FAAM) scores and participated in range of motion, peak force, and peak power testing.Results:All 15 patients were satisfied with their surgery and reported a reduction in their pain level with the average decrease in VAS of 5.59 +/- 2.5 (range: 1 - 9). The mean FAAM was 86.4 +/- 9.7 (range: 52.4 - 100). The mean FFI was 12.8 +/- 9.2 (range: 0 - 21.4). The mean SMFA Function index was 12.4 +/- 8 and the mean SMFA Bothersome Index was 11.5 +/- 11. Patients had on average 58% less eversion and 28% less inversion compared to the nonoperative side. Both isometric peak torque and isotonic peak velocity were decreased by 38.4% and 28.8%, respectively. On average, power in the operative limb was diminished by 56% compared to the nonoperative limb.Conclusion:FDL transfer to the lateral foot for significant, non-reconstructable peroneal tendinopathy is an effective, and durable treatment option.