Digital Tendon Rupture or Laceration


Key Points

The digits (toes) have three tendons

A digit that has rupture of the digital flexor tendons will stick up more than normal

Prognosis is good following surgery

 

Anatomy

  • The digits (toes) have three tendons
    • Two tendons are located on the bottom of the bones (deep digital flexor and superficial flexor tendons) and these serve to flex the toes
    • The flexor tendons are more important than the extensors
    • Another tendon goes to each toe on the top side of the digit and it extends the digits

Causes of digital tendon rupture

  • Laceration from a sharp object such as sharp metal, broken glass, sharp instruments (knives, scissors etc)
  • In some animals the signs of a lacerated tendon (other than a skin wound) is not obvious at the time of initial examination, as the tendon has not been completely severed; if this is not corrected with surgery, the tendon may tear completely in the future resulting in obvious clinical signs of a “sprung toe”
  • Excessive hyperextension of the digit resulting in a tear of the digital flexors

 

Diagnosis

  • The diagnosis of tendon rupture is based on physical examination
  • A digit that has rupture of the digital flexor tendons will stick up more than normal; the result is that the pad does not assume a weight-bearing position, which the result may be sores on the digit because the pad is not contacting the ground when walking and running
  • Take note of the  middle digit that has torn superficial and deep digital flexor tendons; the toe nail rides high in this toe

  • Take note of the small laceration (dog stepped on broken glass) just in front of the large metatarsal pad

 

Treatment options

  • No treatment is an option, but for the best function of the toe, surgery should be done
  • Surgery involves making an incision  over the area to expose the ruptured tendons
  • In the photo below, an incision behind the large metatarsal pad was made as the tendon retracted beneath the metatarsal pad

  • In the photo below a suture has been placed in the lacerated tendon which will be reattached back to the digit

  • The ruptured tendon is sutured together with a locking-loop suture pattern
  • In order to keep the toe in flexion, thereby taking pressure off of the repaired tendon, a mattress suture is placed in the digital pad to the metatarsal (hind limb) or metacarpal (front limb) pad; this suture is removed after about 4 weeks
  • After surgery a cast is applied to support the tendon repair for 2 months
  • If the initial surgery is unsuccessful a podoplasty can be performed which involves removing the skin between the large metacarpal or metatarsal pad and the digital pads and suturing pads together

 

Healing

  • Generally healing of a tendon takes about 2 months

 

Postop care

  • Protect the cast from getting soiled or wet – a plastic bag should be put on the foot when going outside
  • Check the toes to make sure that there is no associated swelling

 


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