| Tendon Transfer post-operative
Post-Operative Course After Flexor Hallucis Longus Tendon Transfer
The First 24 Hours
- Pain Relief
Pain relief after your flexor hallucis longus tendon transfer is by means of a femoral sciatic block which has been done whilst you are asleep. On occasion an ankle block and local anaesthetic infiltration will be used. You have a regular course of three kinds of pain killers after the operation and these will need to continue for 48 to 72 hours.
- Plaster Cast After Flexor Hallucis Longus Transfer
You will be in a lightweight plaster cast following the operation. This is split into a front and back cast whilst you are asleep which allows post-operative swelling of your leg. Following the operation it is important that you keep your plaster cast dry. You will therefore need to have it in a plastic bag with adhesive tape around the top to keep it dry whilst showering or alternatively use a limbo cast cover.
You will be more comfortable with your leg elevated for the first 3-4 days following surgery. This means to have it raised on a single firm bed and when sitting during the course of the day have the leg up next to you as opposed to hanging down as you normally would when sitting on a chair or a couch.
- DVT Prophylaxis
You will be given a dose of low molecular weight Heparin whilst you are asleep, prior to onset of your operation. You will require a once daily injection of a low dose of low molecular weight Heparin which you will be taught to give yourself. This continues for two weeks following operation.
- Length of Stay
You will require one, and occasionally a two night post-operative stay in hospital.
- Physiotherapy
After flexor hallucis longus tendon transfer on the day or the day following surgery you will be mobilised by the physiotherapist and non-weight bearing. This will mean using two crutches for walking. You will continue non-weight bearing for six weeks after the operation date.
Out-Patient Visit at Two Weeks
At this stage your cast will be removed to check the wounds have healed. You will be placed into a further but complete below knee cast which remains in place for a further four weeks. You will continue non-weight bearing.
Out-Patient Visit at Six Weeks
At this stage your cast will be removed and you will be placed into an Achilles Aircast walking boot or alternatively a lightweight walking boot. You will require physiotherapy supervision to assist with a progressive range of movement followed by strengthening exercises. You will normally require the use of a pair of crutches for a further week or two.
At Three Months Following Flexor Hallucis Longus Transfer
At three mohths following flexor hallucis longus transfer you will be able to be fully out of your Aircast boot at this stage. You will not yet be able to return to sport and this will probably take a few more months for adequate muscle power and control to be sufficient.
It may take twelve months to achieve full strength and confidence following a transfer.
Complications Following a Flexor Hallucis Longus Transfer
- Partial/no resolution of symptoms - 5–15%
- Recurrence of symptoms - 10%
- Wound problems - 1-2% : delayed healing, wound breakdown, scar sensitivity, adhesion of scars attendant
- Deep vein thrombosis/pulmonary embolus – 0.5%
- Wound infection – 1%
- Delayed return to function/activities
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