Closed, Atraumatic, and Spontaneous Extensor Hallucis Longus Tendon Rupture Following Multiple Steroid Injections and Presence of Talonavicular Osteophyte Repaired using a Turndown Flap: A Case Report.

INTRODUCTION

We present a case of spontaneous rupture of the extensor hallucis longus (EHL) tendon with significantly retracted tendon edges in a patient who had received multiple steroid injections to an arthritic talonavicular joint repaired using novel turndown flap technique.

CASE REPORT: This case details a patient who came in with a history of spontaneous EHL tendon rupture on a background of chronic pain in the midfoot due to osteoarthritis with osteophytes at the talonavicular joint for which they had received multiple steroid injections in the past. A novel repair technique was employed which involved split lengthening the proximal segment of the ruptured EHL tendon and making a turndown flap of the same by rotating the lengthened segment 180°, bridging the tendon gap. The lengthened tendon is then sutured to the distal segment of the EHL to achieve a tension-free repair. This bypasses any use of bridging allografts and autografts/tendon transfer, removing complications commonly associated with them.

CONCLUSION

This turndown flap technique is easy to perform, reduces surgical time, avoids complications associated with tendon grafting, and results in good functional outcomes for the patient.