Repair and Rehabilitation of Extensor Hallucis Longus and Brevis Tendon Lacerations in a Professional Dancer

STUDY DESIGN: Case report. BACKGROUND: Tendon lacerations of the hallux are potentially devastating to a dancer. Strength of the hallux musculature is necessary to attain and maintain balance, push off in multiple turns, and decelerate in jumps and hops. The purpose of this paper is to report on the repair and rehabilitation of extensor hallux longus (EHL) and brevis (EHB) tendon lacerations in a professional dancer. CASE DESCRIPTION: A 30 year-old dancer sustained complete laceration of her EHL and EHB tendons and partial laceration of the dorsal aspect of the hallux metatarsophalangeal (MTP) joint capsule. Following primary repair, at 9-weeks post-surgery, hallux MTP joint active dorsiflexion was limited to 5º and passive dorsiflexion to 70º. First toe dorsiflexion and plantar flexion strength was 4/5 at the MTP and 3+/5 at the interphalangeal (IP) joint. Rehabilitation included functional electric stimulation to address considerable calf atrophy, strengthening, functional retraining, and progressive return to dance. OUTCOME: The dancer returned to her previous level of dancing in 18 weeks, with 73º and 85º of hallux MTP joint active and passive dorsiflexion and 30º / 35º of active / passive plantar flexion. Hallux MTP and IP joint muscle strength were 5/5 and 4+/5 respectively. Improvement, manifested in her SF-36 and Dance Functional Outcome System scores, accompanied her full functional recovery. DISCUSSION: Hallux stability provided by co-activation of the great toe extensors and flexors is crucial to accomplish the demands of bi- and unipedal balances and activities in dance. This report demonstrates the success of primary surgical repair and rehabilitation in a dancer-athlete experiencing this injury. 

J Orthop Sports Phys Ther., Epub 22 January 2008, doi:10.2519/jospt.2008.2749

KEY WORDS: dance injury, foot, hallux, metatarsophalangeal joint

Hallux stability provided by co-activation of the great toe extensors and flexors is crucial to accomplish the demands of bi- and unipedal balances and activities in dance. This report demonstrates the success of primary surgical repair and rehabilitation in a dancer-athlete experiencing this injury.