Repair and Rehabilitation of Extensor Hallucis Longus and Brevis Tendon Lacerations in a Professional Dancer

Abstract

Case report. Tendon lacerations of the hallux are potentially devastating to a dancer. Strength of the hallux musculature is necessary to attain and maintain balance, push-off in multiple turns, and decelerate in jumps and hops. The purpose of this paper is to report on the repair and rehabilitation of extensor hallucis longus and extensor hallucis brevis tendon lacerations in a professional dancer. A 30-year-old dancer sustained complete laceration of her extensor hallucis longus and extensor hallucis brevis tendons, and partial laceration of the dorsal aspect of the hallux metatarsophalangeal (MTP) joint capsule. Following primary repair, at 9 weeks postsurgery, hallux MTP joint active dorsiflexion was limited to 5 degrees and passive dorsiflexion to 70 degrees . First toe dorsiflexion and plantar flexion strength was 4/5 at the MTP and 3+/5 at the interphalangeal joint. Rehabilitation included functional electrical stimulation to address considerable calf atrophy, strengthening exercises, functional retraining, and progressive return to dance. The dancer returned to her previous level of dancing in 18 weeks, with 73 degrees and 85 degrees of hallux MTP joint active and passive dorsiflexion, and 30 degrees and 35 degrees of active and passive plantar flexion, respectively. Hallux MTP and interphalangeal joint muscle strength were 5/5 and 4+/5, respectively. Improvement, manifested in her SF-36 and Dance Functional Outcome System scores, accompanied her full functional recovery. Hallux stability provided by coactivation of the great toe extensors and flexors is crucial to accomplish the demands of bipedal and unipedal balances and activities in dance. This report demonstrates the success of primary surgical repair and rehabilitation in a dancer/athlete experiencing this injury.