Introduction: This video demonstrates Achilles tendon reconstruction via flexor hallucis longus (FHL) tendon transfer.

Methods: The video discusses the case presentation of a 52-year-old man who was in a motorcycle accident 9 months ago and is complaining of persistent posterior right ankle pain. Physical examination revealed a bulbous deformity about the distal aspect of the Achilles tendon and a palpable 4-cm gap at the midsubstance of the Achilles tendon. MRI revealed a complete tendon rupture 3 cm proximal to the calcaneal tuberosity with 4.5 cm of retraction.

Results: Given the chronicity of the rupture, the extent of tendon retraction, and the patient’s disability, reconstruction of the plantar flexion mechanism of the ankle joint and Achilles tendon reconstruction with cadaver allograft as well as augmentation via FHL tendon transfer are indicated.

Conclusion: The technique of Achilles tendon reconstruction via Achilles tendon allograft and augmentation via FHL tendon transfer affords a robust plantar flexion mechanism of the ankle, restoring the native muscle-tendon length relationship. FHL tendon augmentation acts as an internal brace to maintain the allograft/native tendon repair during rehabilitation and acts as an active muscle unit to aid in plantar flexion strength.