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Hi All

I saw a patient today with US confirmed FHL rupture; approx three weeks post onset of initial pain, no apparent cause, 60YO male no relevent comorbidity.
Retrocalc pain and swelling largely subsided. Retracted ends on US appeared distal to knot of Henry and proximal to Sust Tali.

Ambulated without pain and other than loss of active hallux plantarflexion seems unaffected by injury.

Anyone able to justify need for repair as opposed to neglectful wait?

Cheers
Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

 

Hi Martin
Could you tell what level the rupture was?

I would not bother repairing this...the FHL is often sacrificed in other procedures and patients seem to do fine without it.

Steve

 

Thanks Steve - that makes sense and was my assumption - all I could see was where the retracted ends were so I guess rupture somewhere in between knot of Henry and Sust Tali - I have never come across this before.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

 

Hi Mart,
There's usually an interconnecting tendon between the long flexors around the site of the knot of Henry. As Steve has already said, either one of the long flexors can be sacrificed in some surgeries (eg. FDL transfer for PTTD or FHL augmentation in Achilles' tendon reconstruction). It's likely that the risk of fixing the tear outweighs the benefits in the case you present.
Here's an article that you might find interesting:
http://www.ijav.org/2012/ijav_2012_090-092.pdf

 

Thanks for that Lee; interesting and interconnecting tendon not something I had thought about

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com

 

Martin.

I have been functioning with a ruptured FHL for 7 years with no noticeable deficit.
Sounds very much like the case you describe, just a sharp burning pain at the time ( I was demonstrating high jumping techniques).

Brendan Bennett

 

Hi Brendon

Hope life is sweet on East Coast :). are you making progress with US learning curve?

my patient was doing something less exciting than jumping over sticks - he attributed his injury to a long walk wearing clogs which he felt caused excessive activity of toe flexors to stop shoes falling off feet - sounds plausible.

Cheers

Martin

Foot and Ankle Clinic
1365 Grant Ave.
Winnipeg Manitoba R3M 1Z8
phone [204] 837 FOOT (3668)
fax [204] 774 9918
www.winnipegfootclinic.com