Abstract
The development of claw toe deformity following fracture of the tibia in children has not been described in our review of the literature. We report on the management of the acquired claw toe deformity after tibia fracture in five children. We report on five patients, between 5 and 15 years of age, who developed clawing of the hallux following a fracture of the tibia. In two patients, the lesser toes were involved. On examination, when the ankle was passively plantar flexed, a flexion contracture of the interphalangeal joint of the hallux became fully flexible. When the ankle was dorsiflexed, the clawing became more obvious and fixed. A magnetic resonance imaging (MRI) study in two cases demonstrated fibrosis under or just proximal to the tarsal tunnel. The contractures were relieved by performing a tenolysis proximal to the medial malleolus. The operative findings demonstrated that the etiology could be possibly associated with a localized subclinical compartment syndrome. We described five patients with a claw toe deformity following a tibia fracture associated with adhesions of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles to the surrounding structures under or just proximal to the flexor retinaculum. It is the authors' opinion that this condition may be related to a subclinical compartment syndrome localized in the distal part of the deep posterior compartment. Soft-tissue release without tendon lengthening allowed recovery in all patients.
Highlights
Claw toe deformation has been widely described after compartment syndrome of the foot in children and adults [1,2,3]
The acquired clawing of the toes may be the consequence of a fracture of the distal tibia [5] or fibula [6], in which there is an entrapment of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) in the fracture callus
We report on five patients, less than 16 years of age, with claw toe deformities developed after tibia fracture in the absence of any evidence of a deep posterior leg or foot compartment syndrome
Summary
Claw toe deformation has been widely described after compartment syndrome of the foot in children and adults [1,2,3]. Acquired clawing of the toes can occur after compartment syndrome of the deep posterior muscles of the leg, which produces a fixed length phenomenon of the long flexors of the toes. A fixed tethering of the FHL tendon under or just proximal to the flexor retinaculum a few months after a fracture of the lower quarter of the tibia has been described [5, 7]. In these situations, the principal manifestation is a flexion contracture of the interphalangeal (IP) joint of the hallux, in which plantar flexion of the ankle partially corrects the deformity and dorsiflexion increases it
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