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Claw toes after tibial fracture in children

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

The development of claw toe deformity following fracture of the tibia in children has not been described in our review of the literature. We report on the management of the acquired claw toe deformity after tibia fracture in five children.

Methods

We report on five patients, between 5 and 15 years of age, who developed clawing of the hallux following a fracture of the tibia. In two patients, the lesser toes were involved. On examination, when the ankle was passively plantar flexed, a flexion contracture of the interphalangeal joint of the hallux became fully flexible. When the ankle was dorsiflexed, the clawing became more obvious and fixed. A magnetic resonance imaging (MRI) study in two cases demonstrated fibrosis under or just proximal to the tarsal tunnel.

Results

The contractures were relieved by performing a tenolysis proximal to the medial malleolus. The operative findings demonstrated that the etiology could be possibly associated with a localized subclinical compartment syndrome.

Conclusions

We described five patients with a claw toe deformity following a tibia fracture associated with adhesions of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles to the surrounding structures under or just proximal to the flexor retinaculum. It is the authors’ opinion that this condition may be related to a subclinical compartment syndrome localized in the distal part of the deep posterior compartment. Soft-tissue release without tendon lengthening allowed recovery in all patients.

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Acknowledgments

None of the authors received financial support for this study.

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Authors and Affiliations

  1. Robert Debré Hospital, AP-HP, Paris and Denis Diderot University, Paris 7, France

    Frank Fitoussi, Brice Ilharreborde, Florent Guerin, Philippe Souchet, Georges F. Penneçot & Keyvan Mazda

  2. Orthopaedic Department, Robert Debré Hospital, 48 Boulevard Serrurier, 75019, Paris, France

    Frank Fitoussi

Authors
  1. Frank Fitoussi
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  2. Brice Ilharreborde
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  3. Florent Guerin
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  4. Philippe Souchet
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  5. Georges F. Penneçot
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  6. Keyvan Mazda
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Corresponding author

Correspondence to Frank Fitoussi.

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Fitoussi, F., Ilharreborde, B., Guerin, F. et al. Claw toes after tibial fracture in children. J Child Orthop 3, 339–343 (2009). https://doi.org/10.1007/s11832-009-0200-y

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  • DOI: https://doi.org/10.1007/s11832-009-0200-y

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