Summary
There is a scarcity of information on extensor hallucis longus tendon injuries and
published studies frequently offer conflicting treatment recommendations and results.
Patients and methods
This paper reports on the treatment and results of open lacerations of the extensor
hallucis longus tendon in 17 patients treated by a plastic surgeon over a period of
12 years. All injuries occurred due to industrial accidents. All patients were males
with a mean age of 30 years (range=21–49 years). All zones of tendon injury were represented except zones 2 and 5. Sixteen
patients underwent surgical exploration within 24 h of injury and one patient had a delayed repair using a tendon graft. The laceration
of the tendon was complete in 15 patients, and in these patients, the tendon repair
was protected for 6 weeks using k-wires to the big toe and short-leg walking cast.
The remaining two patients had partial tendon lacerations and were treated conservatively
(without tendon suturing) and immediate unrestricted mobilisation. One patient had
significant soft tissue loss requiring reverse sural artery flap cover. At final follow-up
(mean=3 months), the results of tendon repair were assessed as per the grading system of
Lipscomb and Kelly, and the AOFAS hallux score for pain (maximum score of 40 points
indicating no pain) and for functional capability (maximum score of 45 points).
Results
All patients healed with no infections or painful neuromas. Two patients experienced
prolonged mild aching pain in the foot on walking, but the pain eventually resolved
in both patients. All patients returned back to work 2.5–5 months after surgery. As
per Lipscomb and Kelly's grading system, the result was graded as good in four patients
and fair in the remaining 13 patients. No poor results were seen. The AOFAS hallux
pain score was 40 points in all patients and the mean functional capability score
was 42.1 points (range=40–45 points).
Conclusion
A large series of extensor hallucis longus tendon lacerations is reported. Treatment
and the methods of immobilisation are given for various zone and injury types. Although
it is difficult to obtain a completely normal range of motion of the big toe after
surgery, all patients are expected to recover good active extension and return back
to work pain-free.
Keywords
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Article info
Publication history
Published online: July 04, 2006
Accepted:
May 9,
2006
Received:
January 19,
2006
Identification
Copyright
© 2006 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.
