Acute Achilles tendon rupture missed or misdiagnosed at initial presentation evolves into a chronic rupture — defined as a rupture presenting more than 4–6 weeks after injury. The retracted tendon stumps fill with scar tissue, the proximal gastrocnemius-soleus complex shortens from disuse, and the gap between tendon stumps may reach 3–6 cm or more. Chronic ruptures cannot be treated with primary end-to-end repair; reconstruction using augmentation or tendon transfer is required, and the surgical complexity increases with gap length and time from injury.

Reconstruction by Gap Length

Gap 1–3 cm (small chronic rupture): V-Y advancement of the proximal gastrocnemius-soleus — the proximal tendon is mobilized by releasing adhesions and lengthened by creating a Y-shaped incision in the proximal tendon substance, allowing distal advancement to bridge the gap without tension. This technique preserves the native Achilles tendon tissue. Gap 3–6 cm (moderate chronic rupture): FHL (flexor hallucis longus) tendon transfer — the FHL is harvested from its musculotendinous junction through a separate medial incision, routed through a drill hole in the calcaneus, and used as a motor transfer to restore active plantarflexion power. FHL transfer provides the strongest augmentation available and is the most commonly employed reconstruction for gaps >3 cm. Gap >6 cm (large chronic rupture): allograft reconstruction using Achilles allograft or tibialis anterior allograft to bridge the defect, combined with FHL transfer for motor function. Allograft provides structural continuity but does not contribute active contraction — the FHL transfer restores dynamic function.

Outcomes

Return to ambulation occurs at 10–14 weeks; return to recreational sport at 9–12 months. Functional outcomes are consistently inferior to acute Achilles repair due to the irreversible muscle atrophy and contracture that develops during the delay — but the majority of patients achieve satisfactory walking function and significant improvement from their preoperative state. Dr. Biernacki at Balance Foot & Ankle evaluates Achilles tendon pathology and delayed rupture presentations at both Southeast Michigan offices. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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Frequently Asked Questions

When should I see a podiatrist?

See a podiatrist for any foot or ankle pain that persists more than 2 weeks, doesn’t improve with rest, limits your daily activities, or is accompanied by swelling, numbness, or skin changes. People with diabetes or circulation problems should see a podiatrist regularly even without symptoms.

What does a podiatrist treat?

Podiatrists diagnose and treat all conditions of the foot, ankle, and lower leg including plantar fasciitis, bunions, hammertoes, toenail problems, heel pain, nerve pain, diabetic foot care, sports injuries, fractures, and foot deformities — both surgically and non-surgically.

What can I expect at my first podiatry visit?

Your first visit includes a full medical history, physical examination of your feet and gait, and in-office diagnostic imaging if needed (X-rays, ultrasound). We’ll discuss your diagnosis and create a personalized treatment plan. Most visits take 30–45 minutes.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.

Book Online or call (810) 206-1402

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.