Salvage of first metatarsophalangeal joint by creation of artificial extensor hood apparatus.

The purpose of this procedure was to salvage a first metatarsophalangeal joint after extensor hallucis longus tendon rupture, repair, re-rupture, and severe scarring in a 23-year-old female patient who originally underwent a bunionectomy and extensor hallucis longus tendon lengthening surgery. Initially, the existing functional tendon was surgically identified and freed from surrounding scar tissue, which provided only partial improvement. After this surgery, the patient exhibited only 30 degrees of active dorsiflexion of the first metatarsophalangeal joint with pain. To re-establish normal function, an artificial extensor hood apparatus (sling portion only) was later implanted into the first metatarsal head to augment function of the dorsiflexory power of the extensor hallucis longus. After reconstruction and implantation of an artificial extensor hood apparatus, the first metatarsophalangeal joint and extensor hallucis longus tendon have returned to normal function.