Who should not receive an FHL transfer for Achilles rupture?

Who should not receive an FHL transfer for Achilles rupture?

• A. Non-athletic elderly
• B. Competitive sprinter who relies on hallux for sprinting
• C. Diabetic patient
• D. Child

Answer: (B)

The key idea is that a flexor hallucis longus (FHL) tendon transfer uses the big-toe flexor to augment the Achilles repair. Sacrificing the FHL reduces push-off strength from the great toe, which is exactly what sprinting relies on for rapid propulsion. A competitive sprinter who depends on strong hallux function would likely lose speed and propulsion after an FHL transfer, making this option unsuitable. In contrast, for less demanding patients—like a non-athletic elderly person, a child, or someone where medical factors limit options—the trade-off is more acceptable or alternative strategies can be considered. The main point is that the hallux’s toe-off power is crucial for sprinting, so removing or rerouting the FHL is a poor choice for someone who relies on that function.

The key idea is that a flexor hallucis longus (FHL) tendon transfer uses the big-toe flexor to augment the Achilles repair. Sacrificing the FHL reduces push-off strength from the great toe, which is exactly what sprinting relies on for rapid propulsion. A competitive sprinter who depends on strong hallux function would likely lose speed and propulsion after an FHL transfer, making this option unsuitable. In contrast, for less demanding patients—like a non-athletic elderly person, a child, or someone where medical factors limit options—the trade-off is more acceptable or alternative strategies can be considered. The main point is that the hallux’s toe-off power is crucial for sprinting, so removing or rerouting the FHL is a poor choice for someone who relies on that function.