Obtaining Adequate Tension for Extensor Hallucis Longus Tendon Rupture Repair Using Wide-Awake Surgery: A Case Report

Wide-awake surgery has potential advantages for treating extensor or flexor tendon injury. We present a case of chronic extensor hallucis longus injury treated with turn-down reconstruction using wide-awake surgery with a selective nerve block. To the best of our knowledge, this is the first such case reported. The patient had dropped a knife proximal to the right hallux metatarsophalangeal joint. Because direct suturing was thought to be difficult, turn-down reconstruction was performed under a selective nerve block. At 8 months postoperatively, the hallux had 75° of extension in the metatarsophalangeal joint and -5° of extension in the interphalangeal joint, similar to those of the healthy foot. The Japanese Society for Surgery of the foot objective hallux scale score had improved from 87 to 100, and the subjective scores in the subcategories of pain and pain-related, physical functioning and daily living, and shoe-related in the self-administered foot evaluation questionnaire had improved from 82.8 to 94.4, 97.7 to 100, and 50 to 83.3, respectively. Turn-down reconstruction using wide-awake surgery with a selective nerve block can be used for chronic extensor hallucis longus rupture and can be expected to provide good results.