J Korean Foot Ankle Soc.  2015 Mar;19(1):35-38. 10.14193/jkfas.2015.19.1.35.

Checkrein Deformity Due to Flexor Digitorum Longus Adhesion after Comminuted Calcaneus Fracture: A Case Report

• Kim JS
• Lee HS
• Young KW
• Lee KW
• Cho HK
• Lee SY

• KMID: 1958704
• DOI: http://doi.org/10.14193/jkfas.2015.19.1.35

Abstract

The checkrein deformity describes tethering of the flexor hallucis longus tendon, which mainly occurs after fracture of the distal tibia. The deformity increases with dorsiflexion of the ankle and decreases or disappears with plantarflexion of the ankle. In some cases, the deformity may occasionally include the second and third toes. In the current study, the authors experienced secondary checkrein deformity of all lesser toes after open reduction and plate fixation for comminuted fracture of the calcaneus. As a treatment, plate and screws were removed, followed by an additional medial incision which showed a partially ruptured flexor digitorum longus tendon with severe adhesion. Resection of the adhesed tendon and tenodesis of its distal portion to the flexor hallucis longus was performed for correction of the checkrein deformity. Then the lessor toe checkrein deformity recovered immediately. The authors report on this rare lessor toe checkrein deformity after calcaneal fracture fixation with a review of literature.

Keyword

Flexor digitorum longus; Calcaneus; Fracture; Checkrein deformity

MeSH Terms

Ankle
Calcaneus*
Congenital Abnormalities*
Fracture Fixation
Fractures, Comminuted
Tendons
Tenodesis
Tibia
Toes

Figure

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  Figure 1. A 32-year-old male sustained Sander’s type IIA calacaneal fracture with medial fragmentation by a car accident. (A) Initial lateral radiograph show calcaneal fracture. (B) Initial calcaneal axial view show medial fragmentation. (C) Computed tomography coronal view shows Sander’s type IIA calacaneal fracture.

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  Figure 2. (A) Checkrein deformity of lesser toes were diagnosed when the lessor toe clawing aggrevated with ankle dorsiflexion. The medial calcaneal bony bump was explored and excised, then the partially ruptured flexor digitorum longus was resected with its distal portion repaired to flexor hallucis longus using side to side suture. (B) At 12 months following operation, the checkrein deformity disappeared.

• 

  Figure 3. (A) Open reduction and plate fixation was performed for the calcaneal fracture. However, the patient complained of progressive lesser toe clawing at five months, postoperatively. (B) At the 12 months follow-up, axial view of the computed tomography showed protruded medial fragment along the screw shaped like a beak. (C) Excision of the bony bump was performed that caused lessor toe checkrein deformity.

Reference

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