Treatment of extrinsic flexion deformity of the toes associated with previous removal of a vascularized fibular graft

Background: Complications from vascularized fibular bone-grafting are infre quent. We saw six patients who had a painful flexion deformity of the great and lesser toes after a free vascularized fibular graft had been obtained from the ipsilateral leg, In this report, we discuss our management of thes e patients. Methods: Painful flexion deformity of the toes that had developed in six ad ults after removal of a free vascularized fibular graft was treated by cutt ing of the flexor hallucis longus alone in three patients, by lengthening o f the flexor hallucis longus alone in one, and by cutting of both the flexo r hallucis longus and the flexor digitorum longus in two. Results: After an average duration of follow-up of six years and eleven mon ths, the flexion deformity of the great and lesser toes had decreased or di sappeared, leading to improved or fun extension of the digits. Preoperative and postoperative measurements of muscle strength for plantar flexion of t he interphalangeal joints did not change appreciably, Conclusions: Cutting or lengthening of the flexor hallucis longus behind th e ankle provides an adequate release of digital flexion deformities that oc cur after removal of a vascularized fibular bone graft.