Operative Technique

A, A long vertical incision is made, paralleling the lateral border of the Achilles tendon. Through this incision, the Achilles tendon, peroneal tendons, and posterior aspect of the fibular shaft proximal to its physis are exposed.

B, A distally based slip (≈1 cm wide) of Achilles tendon is fashioned. The remaining Achilles tendon is lengthened if necessary.

C, A Bunnell-type suture is passed through the proximal free end of the slip of the Achilles tendon, tubulating the tendon as needed. A trough is made in the posterior distal fibular shaft and, if it is stout enough, drill holes are made proximal to the trough to receive the suture.

D, The free slip of Achilles tendon is sutured into the trough in the distal fibula. The transferred portion of the Achilles tendon should be tensioned so that it is snug in neutral ankle dorsiflexion. If the fibula is too small for holes to be drilled in the cortex, the suture can be passed around the shaft of the fibula or the slip of Achilles tendon can be wrapped around the fibula and sutured to itself. The wounds are irrigated and closed. A well-molded and padded short-leg walking cast is applied with the foot in a neutral position.