A 38-year-old man sustained an Achilles tendon rupture 4 months ago and declined initial treatment. He now walks with a persistent limp, cannot perform a single-leg heel rise, and examination shows a palpable defect with marked weakness of plantarflexion. MRI confirms a retracted 6 cm gap with poor apposition of the torn ends. The most appropriate reconstructive option uses which tendon?

• A Palmaris longus free graft
• B Peroneus brevis
• C Flexor hallucis longus ✓
• D Gracilis free graft

Explanation

Chronic neglected Achilles ruptures with a large retracted gap require augmentation because direct end-to-end repair is impossible once the gap exceeds roughly 2 to 3 cm. Flexor hallucis longus transfer through a drill hole in the calcaneus is the standard reconstruction: the tendon is local, strong, synergistic in push-off, and harvest causes minimal functional loss because the flexor digitorum longus and intrinsic muscles preserve hallux flexion. Free grafts add donor site morbidity without advantage here.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.