Surgical Management of Hallux Extensus Following Ankle Arthrodesis: A Case Report

Hallux extensus is a rare deformity of the great toe characterized by hyperextension at the first metatarsophalangeal (MTP) joint, which can cause pain, impaired gait, and difficulty wearing standard footwear. Surgical intervention is often required when conservative treatment fails. We report the case of a 72-year-old female who developed hallux extensus six months after ankle arthrodesis with plate fixation due to osteoarthritis. The patient presented with significant pain, inability to wear shoes, and difficulty walking. Physical examination revealed flexible hyperextension of the great toe at the MTP joint, and radiographs confirmed hallux extensus without bony abnormalities. The patient underwent a surgical procedure including Z-tenotomy of the extensor hallucis longus, dorsal release of the MTP joint, adductor tendon release, and K-wire fixation. Postoperatively, the patient was placed in a Baruk-type shoe and gradually allowed weight-bearing, followed by physical therapy. At 8 weeks post-surgery, the patient demonstrated complete correction of the deformity, significant relief of pain, and return to normal activities, including walking in regular footwear. No recurrence was observed at the one-year follow-up. This case highlights the effectiveness of a comprehensive surgical approach for hallux extensus, combining tendon lengthening, joint release, and stabilization. Tailoring the surgical technique to the individual patient is essential. Further studies and long-term follow-up are needed to evaluate the durability of this approach.