It's big and it's standing at attention

August 15, 2008 7:11 PM

Broken tibia & fibula, 3.5 months ago, clean snap. I got an intramedullary rod in the tibia, screws at the ankle and knee, and absolutely no recommendations for PT other than some exercises to do at home from the doctor. Everything else seems to have healed well enough, but - my big toe ain't movin', and it's stuck in permanent "up".

Specifically, my big toe won't recline past a certain elevation, and I just can't move it up past a 90 degrees from my ankle. And when I move my foot downward, the toe sticks up. I can't push it down. Even when I'm resting, it's just sticking up, saluting the sky. I do have some movement in the toe, just...not much, so it's not like the muscle is dead or gone. The best way I can describe it is that it feels "shortened". Everything else seems to be healing well enough, but this is frustrating.

I've heard from some more athletically inclined friends that this is a common sports problem, but that it goes away after a day or two. I'm just wondering if any of you out there have had this experience, and how you deal with it. What stretches do you use? What is this a larger symptom of? Specifically what muscles are involved, and what are they doing? How did I end up with such localized atrophying? Did the surgeon slice something he shouldn't have?

Physical therapy, believe you me, I'm going to ask for as soon as I go for my next checkup in two weeks. In the meantime I'm doing the recommended stretches and exercises. But any more suggestions on how to tame my toe are appreciated.

posted by saysthis to health & fitness (3 comments total)

The extensor hallucis longus tendon may have gotten damaged by the break or the operation, and become shortened. I would start by addressing this with the orthopedist, not the physical therapist.
posted by ikkyu2 at 8:48 PM on August 15, 2008

This is more my DH's area, but yea, sounds like something may have been damaged during the operation, and I would go to the orthopaedist. If you do need to have surgery on your foot, I would make sure it's with a foot and ankle specialized orthopaedist.
posted by texas_blissful at 4:25 AM on August 16, 2008

With complete breaks in both bones, and the exigencies of installing an intramedullary rod, I wouldn't be surprised if the tendon ikkyu2 mentions is much as it was before the accident, but now the operation has lengthened your lower leg, making the length of the tendon insufficient.

The site I linked to has drawings of rods inserted in femurs (here is an X-ray of one more like yours, I bet), and the holes for the screws seem to be pre-drilled, probably implying that the rods come in a range of sizes, and the surgeon picks from an assortment the one he thinks will fit you (even if it was custom made, that wouldn't make much difference for this argument). With both bones in your leg broken, they might have had to base their estimate of the correct size on your other leg. Since you have scoliosis, they could have been led a little astray.

If your leg is longer now, it could have consequences for your hips and your back and the way you walk, too. Please be careful as you rehab.
posted by jamjam at 12:57 PM on August 16, 2008