Extensor Tendon Lengthening for Clawtoe Correction
Edited by Dave Townshend, MD
A clawtoe deformity that is not pronounced but does have an associated elevation and extension of the toe, may benefit from a lengthening of the tendon that pulls the toe upwards (Extensor digitorum longus).
The surgical procedure involves an incision over the top of the toe. This procedure is actually performed at the base of the toe, where the tendon runs into the toe. The long tendon that extends the toe is identified. It’s incised in such a way that the tendon is split down the middle, and this allows for the tendon to lengthen. It is then sutured in the newly lengthened position so that the toe can fall down into an improved position. The toe itself is sometimes stabilized with a wire or some means of immobilizing the toe while the tendon heals. Extensor tendon lengthening is often performed in addition to other procedures to correct the toe position (eg PIP fusion, Weil osteotomy)
Recovery usually requires 6 weeks of immobilization or relative immobilization to allow the tendon to heal. It may be possible to move the toe before then, depending on what other procedures have been done.
Potential Surgical Complications
Complications that are relatively specific to a claw toe correction using an extensor tendon lengthening include:
- Under or over lengthening of tendon. If the tendon is over-lengthened, the toe may fall into a more flexed position. If it’s under-lengthened, an inadequate correction may be obtained.
- Failure of the tendon. If the tendon does not heal, the functioning of the tendon may be limited or absent.
- Increase scarring. There can be significant scarring at the base of the toe that can limit the movement of the tendon, and therefore can limit the function of the toe.
- Vascular injury. Injury to the blood supply to the toe is uncommon. However, it is possible for the blood vessels supplying the tip of the toe to be injured. If this does occur, necrosis or partial loss of tissue at the tip of the toe may occur.
In addition to the specific complications listed above, there is the potential for the following general complications:
- Wound healing problems
- Nerve injury
- Blood clots (Deep Vein Thrombosis / DVT)
- Pulmonary embolism
Edited on June 6, 2017
(Originally edited by Stephen Pinney, MD)