Xanthoma tendinosum is a hereditary lipid storage disease marked by formation of papules or nodules in the tendon, especially the extensor tendon of the hand and feet and the Achilles tendon. Xanthoma of the Achilles tendon is a rather rare, interesting orthopaedic condition that has important ramification in internal medicine and dermatology because the lesion is associated with a specific disturbance of lipid metabolism with elevated blood cholesterol level. Author present a case of bilaterally involved Achilles tendon Xanthoma. We performed subtotal resection with gastrocnemius fascial transfer on one side and total resection with peroneus brevis tendon transfer on the other side.