Patient presented with a ruptured extensor Hallucis Longus tendon
Summary:
The patient attended following a referral received to provide an orthosis which would shorten the severed tendon in the hope that the tendon would spontaneously knit together. The lady had severed the tendon by dropping a glass onto an unshod foot. An MRI scan had shown the possibility that the tendon had indeed joined together but may have joined in such a way that the tendon was overlong with her 1st toe resting in a plantar flexed position and the Consultant wanted it in a dorsiflexed position. She had no active dorsiflexion of her first hallux although the muscle was elicited when activated.
Introduction:
The patient had already been seen by the plaster techs who had supplied a Hallux Valgus night splint but had placed the brace medially on the foot as usually worn. The Consultant had apparently been quite perplexed at this and had therefore sent her to orthotics to see if we could provide something better.
Problem:
The orthosis needed to sit on the dorsum of the foot and be in a position to be able to increase dorsiflexion as needed but, also be wearable n a long term basis even in shoes. The patient was aware that she may have struggled to wear inside any shoes due to the nature of the positioning of the toe and the range of dorsi flexion achieved but also, the4 nature of the toe spring present in all footwear. The normal range being between 50 -90 degrees. The ladies natural range was blocked at approximately 70 degrees.
The solution:
After discussion with the patient we decided to try an instep strap with a malleable aluminium bar extending distally to the interphalangeal joint. The distal end needed a toe loop to be able to grip the toe
After discussions with the team leader in Fabrics, she made an instep strap from neoprene which was a simple touch and close fastening mechanism with a leather pocket extending to the I/P joint. The distal end had a simple touch and close Velcro loop to wrap around the toe.
The lady came to clinic to supply the orthosis and was quite pleased with the outcome. The splint once adjusted, held her toe in the maximum dorsiflexion we could achieve. we discussed footwear and she conceded that she may only be able to wear the orthosis at night time which she was happy to do.
Conclusion:
We provided an orthosis which matched the requirements of the Consultant and met the patients expectations. She is happily wearing the orthosis. I am told that the tendon has indeed joined together but still may need surgery to reduce it further.
