# Hallux Flexion Deformity Secondary to Fibula Harvesting in a 10-Year-Old Patient With Neurofibromatosis

## TL;DR

A 10-year-old with neurofibromatosis developed a toe deformity after a fibula surgery, likely due to weakened muscle function.

## Contribution

This case highlights a rare cause of toe flexion deformity linked to prior fibula harvesting and EHL muscle weakness.

## Key findings

- Fibula harvesting led to extensor hallucis longus weakness and unopposed flexor pull.
- Diagnostic assessments ruled out other causes of the deformity.
- Previous surgical history should be considered in similar deformities.

## Abstract

Hallux interphalangeal joint (IPJ) flexion contracture is an uncommon deformity with various underlying causes, including trauma, neurological disorders, and connective tissue pathologies. We present a unique case of a 10-year-old female patient with neurofibromatosis type 1 (NF1) and a history of fibula transposition surgery, resulting in a hallux IPJ flexion contracture. We believe that the loss of the proximal fibular attachment of the extensor hallucis longus (EHL) following fibula harvesting resulted in EHL weakness and unopposed flexor hallucis longus (FHL) pull that eventually led to the contracture. The patient underwent various diagnostic assessments, ruling out other potential causes of the deformity. This case emphasizes the importance of considering previous surgical interventions when encountering flexion contractures of the toes.