Extensor Tendon Lengthening for Clawtoe Correction

Edited by Vinod Panchbhavi, MD  

 

Indications

The tendon that runs on the top of the foot to control the joints in the toe is called the extensor digitorum longus tendon (long extensor tendon of the digit). At times this tendon is contracted or shortened thereby toe bends at the joints and curls up into a ‘claw shape’. Such a deformity in the toe is called a ‘claw toe’ deformity. In order to straighten the toe, lengthening of the extensor tendon to the toe is necessary and is indicated.

Surgical Procedure

The surgical procedure involves a longitudinal 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. The tendon is split in the middle and at either end of the split it is cut sideways but in opposite direction, such that the cut in the tendon looks like a ‘z’. The split portions than slide elongating the tendon. It is then sutured in the newly lengthened position so that the toe can be straightened and then the toe is held straight with a wire or some implant within 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

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

Specific 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, it can flop down and it becomes difficult to actively lift the toe up, when walking barefoot. If it’s under-lengthened, an inadequate correction may be obtained.
• Failure of the tendon to heal. If the tendon does not heal, the functioning of the tendon may be limited or absent.
• Scarring around the tendon or adhesions. There can be significant scarring 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.

General Complications

In addition to the specific complications listed above, there is the potential for the following general complications:

• Infection
• Wound healing problems
• Nerve injury
• Blood clots (Deep Vein Thrombosis / DVT)
• Pulmonary embolism

 

 

Edited on October 5, 2019

Previously edited by Dave Townshend, MD

mf/ 12.3.18