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The dropped big toe.

K Satku1, J T Wee, V P Kumar

  • 1Department of Orthopaedic Surgery, National University of Singapore.

Annals of the Academy of Medicine, Singapore
|March 1, 1992
PubMed
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Surgical procedures near the fibula can injure nerves, causing a dropped big toe. This study explains the anatomy behind this surgical complication and how to avoid it.

Area of Science:

  • Orthopedic Surgery
  • Neuroanatomy

Background:

  • Surgical approaches to the upper fibula are associated with potential postoperative weakness of the great toe extensors.
  • A 'dropped big toe' is a recognized complication following fibular surgery.

Observation:

  • Three cases of surgically induced dropped big toe are presented.
  • Cadaveric dissections were performed to elucidate the anatomical basis of this complication.

Findings:

  • The extensor hallucis longus (EHL) muscle originates in the middle third of the leg.
  • Nerves innervating the EHL run in close proximity to the fibula for approximately 10 cm below the fibular neck.
  • Surgical procedures in the proximal fibula, distal to the initial innervation of the tibialis anterior and extensor digitorum longus, risk damaging the EHL nerve supply.

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Implications:

  • Understanding the precise anatomical course of the nerves supplying the extensor hallucis longus is crucial for surgeons.
  • Careful surgical technique in the proximal fibula region can help prevent iatrogenic nerve injury and subsequent dropped big toe.
  • This anatomical insight aids in minimizing postoperative complications and improving patient outcomes.