title: Claw toes after tibial fracture in children.
abstract: OBJECTIVE
  The development of claw toe deformity following fracture of the tibia in children has not been described in our review of the literature. We report on the management of the acquired claw toe deformity after tibia fracture in five children.
  
  
  METHODS
  We report on five patients, between 5 and 15 years of age, who developed clawing of the hallux following a fracture of the tibia. In two patients, the lesser toes were involved. On examination, when the ankle was passively plantar flexed, a flexion contracture of the interphalangeal joint of the hallux became fully flexible. When the ankle was dorsiflexed, the clawing became more obvious and fixed. A magnetic resonance imaging (MRI) study in two cases demonstrated fibrosis under or just proximal to the tarsal tunnel.
  
  
  RESULTS
  The contractures were relieved by performing a tenolysis proximal to the medial malleolus. The operative findings demonstrated that the etiology could be possibly associated with a localized subclinical compartment syndrome.
  
  
  CONCLUSIONS
  We described five patients with a claw toe deformity following a tibia fracture associated with adhesions of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles to the surrounding structures under or just proximal to the flexor retinaculum. It is the authors' opinion that this condition may be related to a subclinical compartment syndrome localized in the distal part of the deep posterior compartment. Soft-tissue release without tendon lengthening allowed recovery in all patients.
authors.affiliation: Robert Debré Hospital, AP-HP, Paris and Denis Diderot University, Paris 7, France, franck.fitoussi@wanadoo.fr.
authors.forename: Frank
authors.initials: F
authors.lastname: Fitoussi
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Florent
authors.initials: F
authors.lastname: Guerin
authors.forename: Philippe
authors.initials: P
authors.lastname: Souchet
authors.forename: Georges F
authors.initials: GF
authors.lastname: Penneçot
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
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