Lesson of the week: long term sequelae of missed tendon injuries at the ankle

Introduction

Lacerations of the hand and wrist may affect underlying tendons.1 Although lacerations of the ankle are uncommon, injury to underlying structures is still possible. We report on four patients who presented an average of 23 years after injury to the ankle with the consequences of undetected tendon injuries.

Case reports

Case 1—A 43 year old man presented with a painful left flat foot. At 6 years of age he had sustained a laceration with glass below his left medial malleolus. At the time his family did not seek medical attention. Subsequently the inside sole of his left shoe was seen to be wearing out. At 13 years of age he was referred to an orthopaedic clinic and underwent an unsuccessful tendon repair. Inspection showed a 1 cm transverse laceration below his medial malleolus and a fixed pes planus deformity. His hindfoot was in 10° of fixed valgus (figure) and the ankle in 5° of fixed equinus. The patient's ankle-hindfoot and midfoot scores were 22 and 16 respectively with the scoring system of the American Orthopedic Foot and Ankle Society for grading the functional status of the foot and ankle. The maximum score is 100 and lower scores reflect increasing severity of symptoms and disability.2 An x ray film showed degenerative changes of the ankle and hindfoot joints, and ultrasonography of the ankle showed a discontinuity of the tibialis posterior tendon.

Case 2—A 35 year old woman …