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.

ABSTRACT

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.