Treating Checkrein Deformities After Trauma

Author(s): 
Todd Haddon, DPM, Lewis Freed, DPM, and Kate Johnson, DPM

   We directed our initial attention to the lateral aspect of the lower leg and located the healed fibular fracture. Freeing the muscle from the healed fracture site provided a moderate degree of improvement in the deformity but some contracture persisted. Accordingly, we performed a release of the intramuscular portion of the flexor hallucis longus posteriorly, providing the desired release of the contracture.

In Conclusion

The flexor hallucis longus tendon arises from the inferior two-thirds of the posterior surface of the fibula and interosseous membrane. Lee and colleagues described two types of surgical repair for checkrein deformity, one with release of adhesions and Z-plasty lengthening at the musculotendinous junction above the ankle at the fracture site and the other technique involving lengthening of the flexor hallucis longus in the midfoot.6 The authors noted prolonged success with the latter procedures while the more proximally-based procedures had varying degrees of recurrence to the formation of new adhesions.

   In our particular case, the release of adhesions proximally at the location of the fracture callus did not allow for complete reduction of the deformity and more distal release was necessary. Although the gross appearance of the flexor hallucis longus muscle tissue was normal, contracture required the additional intramuscular release. We observed complete resolution of the deformity following this aspect of the procedure.

   Dr. Haddon is in private practice in Mesa, Ariz.

   Dr. Freed is in private practice in Mesa, Ariz.

   Dr. Johnson is a third-year resident at Maricopa Medical Center in Phoenix.

References

1. Kim SH, Lee KT, Smitt RW, Park YU. Checkrein deformity secondary to entrapment of FHL after talus fracture: a case report. Foot Ankle Int. 2010; 31(4):336-338.

2. Carr JB. Complications of calcaneus fractures: entrapment of the flexor hallucis longus: report of two cases. J Orthop Trauma. 1990; 4(2):166-168.

3. Sanhudo JAV, Lompa PA. Checkrein deformity – flexor hallucis tethering: two case reports. Foot Ankle Int. 2002; 23(9):799-800.

4. Fitoussi F, Ilharreborde B, Guerin F, Souchet P, Pennecot GF, Mazda K. Claw toes after tibial fracture in children. J Child Orthop. 2008; 3(5):339-343.

5. Rosenberg GA, Sferra JJ. Checkrein deformity – an unusual complication associated with a closed Salter Harris type II ankle fracture: a case report. Foot Ankle Int. 1999; 20(9):591-594.

6. Lee HS, Kim JS, Park SS, Lee DH, Park JM, Wapner KL. Treatment of checkrein deformity of the hallux. J Bone Joint Surg Br. 2008; 90(8):1055-1058.

Additional References

7. Carranza-Benzaco A, Gomez-Arroyo JA, Fernandez-Torres JJ. Hallux flexus deformity due to entrapment of the flexor hallucis longus tendon after an open fracture of the tibia and fibula. Foot Ankle Surg. 2000; 6(2):133-135.

8. Sammarco GJ, Miller EH. Partial rupture of the flexor hallucis longus tendon in classical ballet dancer. J Bone Joint Surg Am. 1979; 61(1):149-151.

9. Leitschuh PH, Zimmerman JP, Uhorchak JM, Arciero RA, Bowser L. Hallux flexion deformity secondary to entrapment of the flexor hallucis longus tendon after fibular fracture. Foot Ankle Int. 1995; 16(4):232-235.

10. Gould N. Stenosing tenosynovitis of the flexor hallucis tendon of the great toe. Foot Ankle. 1981; 2(1):46-48.

11. Clawson DK. Claw toes following tibial fracture. Clin Orthop Relat Res. 1974; 103:47-48.

12. Feeney MS, Williams RL, Stephens MM. Selective lengthening of the proximal flexor tendon in the management of acquired claw toes. J Bone Joint Surg Br. 2001; 83(3):335-338.

13. Tsai K, Wang C. Checkrein deformity following tibial fractures a report of five cases. J Orthop Surg Taiwan. 2001; 18(4):193-197.

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