Adhesion of flexor hallucis longus at the site of a tibial-shaft fracture – A cause of a checkrein deformity

• Hallux flexus deformity can follow a tibial fracture.
• It can be due to FHL muscle contracture following deep posterior compartment; entrapment of FHL tendon or fibrous adhesion.
• Associated flexion deformity of the second and third toes can occur due to the interconnection of the FHL and FDL tendons at the master knot of Henry.

Post-traumatic adhesion of toe flexors at the tibial fracture site resulted in checkrein deformity is rare and only a few case reports or case series were reported in the English literature. Major differential diagnosis includes deep compartment syndrome or adhesion of the muscle due to various causes. We are not able to conclude what is the best treatment option. Open exploration and adhesiolysis at the adhesion site together with tendon lengthening at the distal tibial level is a feasible surgical option with satisfactory result.