What is the management of a partial extensor laceration of the foot?

Management of Partial Extensor Laceration of the Foot

Initial Assessment and Management

For partial extensor tendon lacerations of the foot, early surgical exploration and repair is recommended to prevent future disability and ensure optimal functional outcomes.

When evaluating a partial extensor tendon laceration of the foot, it's essential to:

• Determine the exact location and depth of the laceration
• Assess the percentage of tendon involvement
• Evaluate for associated injuries (vascular, nerve, bone)
• Rule out infection or foreign bodies

Immediate Management

1. Wound cleansing and irrigation to remove debris and contaminants
2. Antibiotic prophylaxis should be initiated immediately, especially with open wounds 1
3. Tetanus prophylaxis if indicated based on immunization status

Surgical Management

Timing of Intervention

• Surgical exploration within 24 hours of injury is recommended for optimal outcomes 2
• Delayed repair may require more complex reconstruction techniques such as tendon grafting

Surgical Approach Based on Laceration Severity

1. For partial lacerations (<50% of tendon diameter):

   • Conservative management may be appropriate with immobilization
   • No tendon suturing required with immediate unrestricted mobilization 2

2. For complete or severe partial lacerations (>50% of tendon diameter):

   • Direct tendon repair with core sutures
   • Protection of repair with temporary immobilization

Surgical Technique

• Core suture repair using appropriate tendon suture techniques
• For larger defects where direct repair is not possible, consider:
  • Split tendon lengthening technique 3
  • Dermal scaffold augmentation for improved strength and gliding 3

Post-Surgical Management

Immobilization Protocol

• For complete or severe partial lacerations:

  • Immobilization for approximately 6 weeks using:
    • K-wire fixation to the affected toe
    • Short-leg walking cast 2

• For minor partial lacerations:

  • Early controlled mobilization may be appropriate

Rehabilitation Protocol

1. Initial Phase (0-3 weeks):

   • Strict immobilization
   • Elevation and edema control
   • Non-weight bearing or protected weight bearing with appropriate device

2. Intermediate Phase (3-6 weeks):

   • Begin gentle range of motion exercises
   • Gradual weight bearing as tolerated
   • Removal of immobilization devices

3. Advanced Phase (6+ weeks):

   • Progressive strengthening exercises
   • Gait training
   • Return to normal activities

Special Considerations

Diabetic Patients

• More vigilant monitoring required due to increased infection risk 4
• Earlier surgical intervention may be necessary
• Careful wound management and glycemic control are essential

Infection Prevention

• Regular wound inspection
• Appropriate dressing changes
• Continuation of antibiotics if signs of infection present

Expected Outcomes and Follow-up

• Follow-up schedule:

  • Every 2-4 weeks until resolution 4
  • Return immediately if signs of infection develop

• Expected outcomes:

  • Return to work typically within 2.5-5 months 2
  • Most patients achieve good functional recovery
  • Some limitation in range of motion may persist but typically does not affect daily activities

Potential Complications

• Tendon adhesions
• Infection
• Re-rupture
• Permanent deformity
• Functional limitations

Conclusion

Early surgical exploration and appropriate repair of partial extensor tendon lacerations of the foot provide the best outcomes for restoration of function and prevention of long-term disability. The management approach should be based on the severity of the laceration, with complete or severe partial lacerations requiring surgical repair and appropriate immobilization, while minor partial lacerations may be managed conservatively with early mobilization.