FHL Tendon Transfer - Status 18 Weeks Post-op


I am 63 years old.  I climb mountains.  Yes, I am insane.

I wrote off my AT (a total loss) a year ago, March 2015.  Got my surgery on November 20, 2015. As I had no AT left to fix, my surgery was an FHL tendon transfer.

I was out of the cast in two weeks and walking in 10 weeks. I did a ton of research, did some work with PT’s but I have rehabbed this mostly on my own.  I have detailed the rehab program I used in my previous posts.

How did a 63 year old guy progress so quickly?  Yes, I worked at it, but I also cheated.

By continuing to climb after rupturing my AT, I learned to adapt my FHL muscle and tendon (the ones that works your big toe) to stabilize my foot in absence of having an AT.  The FHL tendon goes down the tibia, does a 90 degree turn and attaches to a tendon bundle near the arch.  For a FHL tendon transfer, the doctor snips the tendon above the bundle, drills a hole in your heal, and then anchors the tendon there with a screw. Then he attaches the calf muscles (and what’s left of the AT) to the transferred tendon.  For me, because I had already adapted this tendon and muscle to stabilize my foot, the operation had the wonderful effect of improving the lever arm.

The ultimate result was, after 9 months of strengthening my FHL tendon and muscle prior to the surgery,  my ability to control my foot post-op was abnormally advanced.


It was time to do something stupid and take my new AT out for a serious road test. Well, maybe more that a test, we would climb an actual mountain.

Mt. Gould is directly west of Lone Pine, CA in the eastern Sierras. It is a 13,000 foot peak directly north of Kearsarge pass.  Most of the route would be on snow, so we brought Ice Axes, Crampons and Snow Shoes.

I decided to wear my Salewa Mountain Trainer mid-height gore-tex boots. To add additional protection for my repaired AT,  under the boot I wore my McDavid Classic Lightweight Laced Ankle Brace, which holds the ankle in a slightly extended position and would restrict the movement of my ankle if I messed up.  The brace is THE BEST, extending from 6 inches above the heal to mid-foot, with laces the full length so you can adjust the fit easily. I wear it over my thick climbing socks. It’s $30 on Amazon.

I also brought along a large zip lock plastic bag, so that I could take my boot off, fill the bag with snow, and ice my ankle if I had any issues with pain or swelling.   With all my winter gear my backpack weighted about 3o lbs.


The good news about walking on snow, is that it is mostly soft, which is easier on the feet in general, and was easier on my new AT. No rocks or pounding.

The bad news about walking on snow, is that latter in the day, on the way down, the snow gets soft, which means eventually doing something called a “post hole” where you step on snow which seems firm, and then, suddenly, the firm surface breaks, and your foot and leg drop painfully, so you end up with one leg thigh deep in snow.  This can do all sorts of horrible things to your ankle, even if it is at full strength. But that is something to worry about on the trip down…


The trip up was great.  The highlight was climbing to the top of a 1000 foot snow gully with about a 40 degree pitch by kicking steps in the snow with our crampons.  I had full control of my left foot and my left calf was sufficiently strong enough (supported by the boot and the brace).  In general, traveling uphill was good.  My ankle flexibility had improved enough so that I only felt mild stretching in my new AT and my calf didn’t cramp like it had done two weeks previously.


Downhill, well, that was pretty interesting.  Pick the problem you want to have.  To avoid doing the post hole, we wore snow shoes. I hate snow shoes. Big, flat, long things attached loosely to your feet.  Talk about tripping over your own foot…

Now, if you have been doing PT, you might be familiar with a stability exercise where you stand on one foot (controlled by your new AT)  on a rubber disk, and then you bend over and extend your hand out in front, while your leg wobbles around.  Twenty on each side right?  Walking downhill using snow shoes is EXACTLY like doing that, for, like, three hours.


During the climb I felt some mild tightness in the AT but no pain.  It was a remarkable improvement over climbing without an AT (which I did all last year).

The following day I had mild tingling around my heal and mild soreness in my calf.

There is only one conclusion to be drawn…


I am back.

If you have any questions you can reach me on twitter @aMtnClimber

3 Responses to “FHL Tendon Transfer - Status 18 Weeks Post-op”

  1. MountainClimber, you are one crazy dude!!! Congrats for your endeavor, and making out safe. I am all for challenging oneself, but please be careful!!!

  2. Thanks, but I think insane is more like it.

    [WORDPRESS HASHCASH] The poster sent us ‘0 which is not a hashcash value.

  3. Mountain climber, my new hero!

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