Working Diagnosis:
Acute laceration of the extensor hallicus longus tendon of the left great toe

Treatment:
While non-surgical treatment is an option in cases of acute EHL lacerations, primary repair is considered due to concern for preventing a plantarflexion deformity of the IP joint. The patient opted for surgical repair which was performed later that week. The lacerated tendon edges were secured with a Krackow locking suture technique. There were no surgical complications.

Outcome:
Patient was transitioned from a Bulky Jones Splint post-op to a short leg cast and remained non-weight bearing for 4 weeks. She was then transitioned to weight-bearing as tolerated in a pneumatic walking boot for 4 weeks and physical therapy was begun working on ROM. Pain improved through follow-up. Patient progressed well through physical therapy with only a mild residual toe extension deficit.

Author's Comments:
Our patient sustained an unremarkable 5mm laceration to the dorsum of the foot, however, with noted dropping of the large toe from a neutral position and inability to extend the toe there was concern for an injury to the extensor mechanism. The extensor hallicus longus (EHL) inserts at the dorsal base of the distal phalynx of the great toe and is the main extender of the great toe. The EHL tendon is usually

Editor's Comments:
Given that the mechanism of injury was due to a knife, consideration should be given to rule out infection with CBC/wound culture. 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.

References:
1. Floyd D.W., Heckman J.D., Rockwood Jr.,.A. Tendon lacerations in the foot.
Foot Ankle. 1983; 4: 8-14.
2.Hoelzer W.A., Kalish S.R.
Traumatic severance of the anterior tibial and extensor hallucis longus tendons.J. Foot Surg. 2014; 13: 96-97
3. Wong JC, Daniel JN, Raikin SM. Repair of acute extensor hallucis longus tendon injuries: a retrospective review. Foot Ankle Spec. 2014 Feb;7(1):45-51. doi: 10.1177/1938640013514271. Epub 2013 Dec 10. PMID: 24334369.

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