PMC7322238_01
Pre-, intra-, and post-operative findings.. (a, b) Frontal and lateral views of legs showing a fixed ankle equinus deformity. (c) Ankle plantarflexion showed on x-ray anteroposterior and lateral views, denoting no bony derangement. (d) Z-lengthening of Achilles tendon for addressing Achilles tendon contracture. (e) Intraoperative finding of deep posterior compartment, showing necrotic FHL muscle. (f) Necrotic FHL muscle after excision with ruler as a scale. (g) A 40x haematoxylin-eosin stained histopathological examination revealed hyalinized fibrocollagen, lymphocytic inflammatory cells infiltration, vascular congestion, without signs of malignancy. (h) Ankle arthrodesis state using posterior plate seen on immediate post-operative x-ray.
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The patient presented three months later to our foot and ankle clinic with an obvious fixed equinus deformity of the right ankle and foot with a "soft stop" (Fig. 1a and b). Considering the extensor muscles as well as the antagonist tendons were weak, we decided to perform deformity correction through Achilles tendon lengthening followed by ankle fusion using the same posterior trans-Achilles approach (Fig. 1d). Further exploration revealed a contracture and necrosis of the flexor hallucis longus (FHL) tendon (Fig. 1e and f). The excised tissue was sent for a histopathological examination (Fig. 1g). Ankle fusion was performed using a posterior ankle fusion plate (Fig. 1h).