Massive Tendo Achilles Xanthoma Treated with en bloc Excision and Reconstruction with Flexor Hallucis Longus Tendon Transfer: A Case Report.

Introduction: Tendoachilles xanthomas are rare and generally asymptomatic swellings of tendoachilles. They are believed to be formed due to defects in lipid metabolism. Sometimes, these swellings become inflamed and become painful. If non-operative management fails, these patients are considered for surgery. Case Report: A 25-years-old male patient presented with complaints of progressive swellings on the posterior aspect of both heels for the past 5 years. The left leg swelling was painful for the past 6 months. After thorough evaluation, the patient was diagnosed with bilateral tendoachilles xanthoma with gout. Complete excision of the left xanthomatus tendoachilles and reconstruction of the defect with Flexor hallucis longus (FHL) tendon transfer was done. At 3 months, 6 months and 1 year follow-up; the patient was highly satisfied with the procedure, could walk normally, and stands on the tip of the toes. Conclusion: Complete excision of the xanthoma and reconstruction of the defect is associated with reduced recurrence rates and complete functional restitution. Reconstruction with ipsilateral FHL tendon transfer is a reliable and effective procedure offering a good functional outcome without any complications.