Extensor Hallicus longus tendon laceration

Patient

Q: I cut the extensor hallucis longus tendon on my big toe on the proximal phalange. I can flex my big toe up, but the distal phalange doesn't respond. An MRI showed the cut was 100% through and a podiatrist wants to surgically repair it. However, because of my job, the long recovery time is worrisome and at the moment I can walk and run without pain. Can I go on without the surgery?

Symptoms:  No upward movement in last digit of big toe.
Doctor

A:   Thank you for your question. The externsor hallucis longus tendon attaches the extensor hallucis longus muscle to the big toe allowing the muscle to extend the big toe, dorsiflex the foot, and assist in everting and inverting the foot. The fact that you are not in pain and can function normally is a good sign. However, we cannot be completely certain if this injury is not repaired you will be pain free in the future or be able to have full function of your foot. If you are concerned whether or not surgery is an absolute requirement you can seek a second opinion of another podiatrist. Your recovery time will depend on your ability to heal as well as regain full range of motion, however this type of surgical repair, although routine, does require a long recovery because it is high stress joint.

These types of tears rarely heal on their own, and will eventually require surgical repair. Symptoms of the tear may not be present now, but can develop later on, resulting in you having to miss work due to pain or decreased range of motion in your foot.

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