The toe extensor tendons include the extensor hallucis longus (EHL) and extensor digitorum longus (EDL)
These tendons are located on the top of the foot and dorsiflex or bring the toes up. The usual mechanism of injury is a cut/laceration from a sharp object such as a knife or a broken dish. On examination, the patient will have difficulty or be unable to dorsiflex the injured toes. X-rays are negative. Often times, these patients are seen in the emergency department and the skin laceration is repaired. The emergency department clinician may see that all or part of the tendon is cut. When the patient presents to the office after being evaluated in the emergency department, the examination is very important. When in doubt, an ultrasound is generally the imaging of choice since they can focus on the involved tendon which can be very small and difficult to see the degree of injury on MRI. Complete or significant partial tears are recommended to undergo surgical repair. An important factor in surgical decision making is if this is a chronic laceration. A lacerated tendon is more difficult to repair after time passes. This is particularly true when 2 to 3 months have elapsed. This is due to the retraction of the tendon which makes the repair very difficult or even not possible. Furthermore, the muscle can start to atrophy and be replaced by fat.
It is an outpatient procedure under general or regional anesthesia. The patient will be placed in a nonremovable splint and will be nonweightbearing with crutches. At two weeks, the stitches are removed and the patient is placed in a removable boot. The patient is still on crutches for week three and four. Partial weight-bearing in the boot will begin at four weeks and physical therapy at six weeks. The patient transitions from the boot as they become stronger over the next 4 to 6 weeks.
