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Review Question - QID 6732

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QID 6732 (Type "6732" in App Search)
A 27-year-old man was struck by a taxi cab and sustained comminuted right distal third tibia and fibula fractures; treatment consisted of placement of an intramedullary nail in the tibia the following morning. At his 6-month follow-up, he has clawing of all five toes. Examination reveals flexion deformities of the distal and proximal interphalangeal joints that are flexible with plantar flexion and rigid with dorsiflexion. Calluses are present on the dorsum and tip of the toes. Single heel rise is normal. He has a mild equinus contracture (relative to the left leg) that is not relieved with knee flexion. What is the most appropriate treatment option?

Physical therapy and bracing

11%

66/622

Reassurance that the deformity will resolve with time

0%

3/622

Achilles tendon lengthening, and release or retromalleolar lengthening of the flexor digitorum longus (FDL) and flexor hallucis longus (FHL)

66%

410/622

FDL and FHL tenotomies at the individual digits with transfer of the posterior tibial tendon to the dorsum of the foot

14%

86/622

FDL and FHL tenotomies at the individual digits with midfoot capsular release and hallux interphalangeal fusion

8%

49/622

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This is an example of tethering of the flexor hallucis longus/flexor digitorum longus (FHL/FDL) to the fracture site. Additional time and/or physical therapy and bracing would not be expected to be of benefit. Release of the FHL and FDL from the fracture site or retromalleolar lengthening will address the posttraumatic claw toe deformity and Achilles tendon lengthening will address the mild equinus. Posterior tibial tendon transfer is not appropriate as the patient demonstrates a normal heel rise. Midfoot releases and hallux fusion are also not indicated.

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