Tendon split lengthening technique for flexor hallucis longus tendon rupture

Jae Yong Park,Chenyu Wang,Hyong Nyun Kim,Hee Dong Kim

doi:10.1186/s13018-017-0668-y

Abstract

BackgroundFlexor hallucis longus (FHL) tendon rupture is a challenging injury to lead with clawing of the great toe when the FHL tendon is repaired too tight. When the diagnosis is delayed, the tendon ends may not be opposable because of contracture or poor tendon tissue.MethodsA technique to reconstruct FHL tendon rupture without a free tendon graft is described. A split tendon lengthening is performed at the midfoot around the knot of Henry. Ankle block anesthesia is used to allow the patient’s active movement of the interphalangeal (IP) joint to determine the appropriate length of the reconstructed tendon for maintaining balance and preventing the tendon from being too tight or too loose. Between May 2012 and September 2015, five patients with a total rupture of the FHL tendon, having tendon defect distal to the knot of Henry, were treated with split tendon lengthening.ResultsFour patients could actively plantarflex the great toe IP joint. One patient who was operated under spinal anesthesia could not actively plantarflex the great toe IP joint, but did not have extension deformity and did not want another procedure. The mean American Orthopedic Foot and Ankle Society (AOFAS) score at a mean follow-up of 44 months was 92 points (range, 80–100).ConclusionsThis technique is described to overcome the difficulty of reconstructing the FHL tendon with tendon defect. The tendon defect could be repaired after split tendon lengthening without a free tendon graft.

Highlights

Flexor hallucis longus (FHL) tendon rupture is a challenging injury to lead with clawing of the great toe when the FHL tendon is repaired too tight
The flexor hallucis longus (FHL) tendon plantarflexes the distal phalanx of the great toe generating the last push-off power for walking, running, and jumping [1]
Pneumatic tourniquet was inflated at the calf, and the rubber tourniquet applied around the ankle was released, because we found that compression around the ankle plantarflexed the great toe making the tendon too tight to measure the balance

Summary

Introduction

Flexor hallucis longus (FHL) tendon rupture is a challenging injury to lead with clawing of the great toe when the FHL tendon is repaired too tight. The flexor hallucis longus (FHL) tendon plantarflexes the distal phalanx of the great toe generating the last push-off power for walking, running, and jumping [1]. The FHL tendon is at risk during hallux surgery, such as Akin osteotomy, metatarsal osteotomy, or soft tissue release, because it passes close to the plantar aspect of the proximal phalanx and the metatarsal head [5, 6]. Total rupture of the FHL tendon distal to the knot of Henry, the fibrous slip connecting the FHL and the FDL, can cause loss of push-off strength and later cause hyperextension deformity of the IP joint [3]. Thompson et al [11] described a patient who complained that the dorsum of her great toe rubbed against the toe box of her shoe because of an extension deformity at the IP joint

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