Ultrasound was performed in the clinic. The right great toe was visualized form the plantar aspect. The FHL was visualized form the mid foot in longitudinal view and followed int he view along the MTP joint. Tendon was noted to be completely disrupted along with an area of hypo-echogenicity and no clear tendon lines just distal to the MTP joint. The insertion was noted to not connect at the distal phalange Case Photo #1. For comparison the left foot was visualized and the FHL is clearly followed from the mid portion of her arch to the insertion at the distal phalange. Case Photo #2 Dynamic testing was done under US showing movement of the tendon with flexion of the great toe not he left and clear disruption on the right.
Normal alignment of metatarsals. Symmetry within sesamoid bones. No evidence of mid foot collapse or fractures. Case Photo #3 Case Photo #4
Chronic FHL tendon rupture in the arch area. No evidence of flexor hallicus brevis disruption. The sesamoids are intact. Sagittal with measurement Case Photo #5, Sagittal Case Photo #6, Axial with measurement Case Photo #7, Axial Case Photo #8
Consultation with foot and ankle surgery. An X-ray was obtained. An MRI was ordered but due to training requirements and patient being asymptomatic, the MRI was completed after the season (6 weeks most initially noticing injury).
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