From the Research
Treatment of extensor tendon lacerations in pediatric feet requires prompt surgical repair followed by appropriate immobilization. The initial management involves cleaning the wound, administering appropriate antibiotics (such as cefazolin 25-50 mg/kg/day divided every 8 hours for 5-7 days), and tetanus prophylaxis if needed. Surgical repair should be performed within 24 hours if possible, using fine absorbable sutures (typically 4-0 or 5-0 Vicryl) with a modified Kessler or figure-of-eight technique, as supported by the case report of a 9-year-old male who suffered a traumatic wound laceration and underwent successful surgical repair and rehabilitation 1.
Following repair, the foot should be immobilized in a short leg cast or splint with the ankle in neutral position and the toes slightly extended for 4-6 weeks, depending on the child's age and the severity of the injury. Younger children may require shorter immobilization periods (3-4 weeks) due to faster healing, while older children typically need 4-6 weeks. After immobilization, a progressive rehabilitation program should be initiated, starting with gentle passive range of motion exercises and gradually advancing to active motion and strengthening over 2-4 weeks.
Key considerations in the treatment of extensor tendon lacerations in pediatric feet include:
- Prompt surgical repair to minimize complications and promote optimal healing
- Appropriate immobilization to protect the repair and allow for healing
- Progressive rehabilitation to restore range of motion and strength
- Close follow-up to monitor for complications such as adhesions, rupture, or tendon bowstringing, which are less common in children than adults but still possible, as noted in the review of extensor tendon injuries specific to the pediatric patient 2.
It is essential to prioritize the most recent and highest quality study, which in this case is the 2019 case report 1, to guide treatment decisions and optimize outcomes for pediatric patients with extensor tendon lacerations of the foot.