Extensor Hallucis Longus Tendon Injuries

NewsBot · Dec 18, 2013

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Repair of Acute Extensor Hallucis Longus Tendon Injuries: A Retrospective Review.
Wong JC, Daniel JN, Raikin SM.
Foot Ankle Spec. 2013 Dec 10.

Background. Extensor hallucis longus (EHL) tendon injuries may occur with lacerations sustained over the dorsum of the foot and lead to hallux dysfunction. Primary repair is performed when tendon edges are opposable; however, if a gap exists between tendon edges, then reconstruction with tendon graft or tendon transfer may be necessary to restore hallux alignment and dorsiflexion. We describe the surgical technique and report the results on a large series of patients having undergone primary repair or reconstruction of EHL tendon lacerations.

Methods. We retrospectively reviewed all patients undergoing EHL tendon repair or reconstruction between January 2005 and May 2012. Information on patient demographics, mechanism of injury, time to surgery, intraoperative findings, surgical repair or reconstruction technique, and postoperative function were collected. Patients were contacted by telephone for administration of the Foot and Ankle Ability Measure (FAAM) and American Orthopaedic Foot and Ankle Society Hallux questionnaires.

Results. Twenty of 23 patients undergoing EHL tendon repair or reconstruction were available for review at an average clinical follow-up of 12 months (range 3-89 months) and an average telephone follow-up of 5.1 years (range 1-10.4 years). Primary EHL repair was performed in 80% of cases, with the remaining patients undergoing reconstruction with deep tendon transfer of the extensor digitorum longus tendon from the second toe. At final follow-up, 19 of 20 patients had active hallux dorsiflexion. The average FAAM Activities of Daily Living score was 94.2% (range 58.3% to 100%) and the average FAAM Sports score was 94.2% (range 65.6% to 100%).

Conclusion. Primary repair or reconstruction of EHL tendon lacerations is a reliable procedure that restores hallux alignment and function in most patients as measured by the validated FAAM questionnaire. Deep tendon transfer from the extensor digitorum longus may be performed if EHL tendon edges are not opposable thus eliminating the need for allograft reconstruction
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Admin2 · Dec 18, 2013

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Extensor Hallucis Longus Tendosynovitis

NewsBot · Jun 3, 2022

Case series of traumatic neglected Extensor Hallucis Longus lacerations: choice of surgical treatment based on injury type
Miriam Grassi et al
Acta Biomed. 2021 Dec 29;92(S1):e2021349

Background and aim: Extensor Hallucis Longus (EHL) tendon rupture is a rare injury of the foot, representing only 1% of overall tendon rupture. Early diagnosis and surgical repair are recommended but there is still no consensus regarding the ideal treatment. The purpose of this study was to evaluate a case series of patients with neglected extensor hallucis longus (EHL) tendon rupture.

Methods: We report a case series of 3 patients affected by traumatic neglected EHL lacerations treated with reconstructive surgery using tissue scaffolds, between November 2019 and May 2020. Demographics data, mechanism of injury, zone of injury, tendon gap, time to surgery, type of surgical repair, preoperative and postoperative functional score were collected with a minimum follow-up of 8 months.

Results: The zone of injury (according to Al-Qattan classification) involved was in 1 case zone 2, in 1 case zone 4 and in the last case zone 5. The mean value of intraoperative tendon gap was of 3,4 cm. The elapsed time from injury to surgery was an average of 3,3 months. One tendon transfer surgery and two primary repairs with Krakow fashion were performed, all augmented with tissue scaffolds. The mean preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores were, respectively, 43 and 97.

Conclusions: Our results highlight good functional result and satisfaction with active extension of the hallux restored in all patients. According to our experience, we recommend choosing reconstruction technique basing on the topographic zone of lesion and intraoperative tendon gap.
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NewsBot · Jul 4, 2023

A Neglected Extensor Hallucis Longus Tendon Rupture Caused by Arthritic Adhesion
Sung Hun Won et al
Medicina (Kaunas). 2023 Jun 1;59(6):1069

Extensor hallucis longus tendon injury is relatively rare and is principally caused by a laceration when a sharp object is dropped on the instep. Primary suturing is possible if the injury is acute, but if the tear is chronic, tendon contracture causes the space between the edges of the tear to widen, disrupting the end-to-end connection. In particular, a claw toe or checkrein foot deformity may develop over time due to adhesion of the lower leg tendons near the fracture site or scar. We report on a 44-year-old man who visited our outpatient clinic complaining of pain in the right foot and a hindered ability to extend his great toe. He had enjoyed playing soccer during his schooldays; since that time, the extension of that toe had become somewhat difficult. T2-weighted sagittal magnetic resonance imaging revealed that the continuity of the extensor hallucis longus tendon had been lost at the distal phalangeal base attachment site, and that the region of the proximal tendon was retracted to level of the middle shaft of the proximal phalanx. The findings allowed us to diagnose extensor hallucis longus tendon rupture accompanying osteoarthritic changes in the joint and soft tissues. We performed surgical tenorrhaphy and adhesiolysis. This is a rare case of extensor hallucis longus tendon rupture caused by minor trauma. Arthritis that developed at a young age caused the adhesions. If patients with foot and ankle arthritis show tendon adhesion at the arthritic site, tendon rupture can develop even after minor trauma or intense stretching.
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NewsBot · Jan 17, 2024

Physiotherapy Management Post-operative to Total Extensor Hallucis Longus Rupture: A Case Report
Akanksha R Hege et al
Cureus. 2023 Dec 13;15(12):e50434

Due to the contracture or degeneration of the ruptured tendon, using primary suturing to treat chronic extensor hallucis longus (EHL) tendon ruptures is challenging. The most common cause of EHL rupture is a laceration when a sharp object drops over the dorsum of the foot. EHL injuries are rare cases. In this report, we present a case of a 23-year-old female who was operated on for EHL rupture; she visited the Physiotherapy department with complaints of pain swelling over the left dorsum of the foot and was unable to perform great toe movements for six weeks. After three weeks of patient-tailored rehabilitation protocol that included interventions like faradic stimulation, strengthening exercises, gripping exercises, proprioception training, etc., we assessed the patient's primary outcomes like pain intensity, muscle strength, and range of motion and functional outcome measures that included lower extremity functional scale score at the end. Improvement in all the outcomes was seen. Our case report concludes that physiotherapy intervention has improved the primary and secondary outcomes and has helped patients to perform functional activities efficiently, such as maintaining balance while standing, walking, and bearing equal weight. This case report portrays that early physiotherapy treatment post-operatively in EHL rupture cases proves to be very beneficial.
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