Post-Tibial Fracture Surgery: Why Can't I Lift My Big Toe?

After tibial fracture surgery, the big toe cannot be lifted?

Hello, Doctor.
I would like to ask you: I was involved in a car accident on March 10 of this year, which resulted in a comminuted fracture of my right tibia.
I underwent intramedullary nailing surgery on March 11, during which bone grafting was performed.
A week later, the wound healed, and I returned for suture removal with no abnormalities.
However, on March 31, I developed an infection in the wound for unknown reasons and was hospitalized.
On April 1, the doctor performed debridement surgery and removed the original intramedullary nail.
I then received antibiotic treatment for the infection until my discharge on April 19.

During my hospitalization, I noticed that I could not lift my right big toe, but I could press it down.
The other four toes function normally.
The inability to lift my big toe is accompanied by numbness or reduced sensation in the skin area extending from the big toe and index toe to the entire ankle.
At that time and during subsequent follow-up visits, the doctors told me that my condition would gradually return to normal as the injury healed.

I would like to ask the doctor: 1.
What could be the reason for my inability to lift my big toe? 2.
Is it really okay not to actively investigate and address this issue? I am very concerned that if I do not recover on my own, it may delay the critical treatment window and lead to lifelong consequences.
I would appreciate your advice.
Thank you!

A Guo, 40~49 year old female. Ask Date: 2021/07/08

Dr. Wang Shouji reply Orthopedics

Hello,
1.
If the big toe cannot be lifted while the other toes can, the first consideration should be whether there is any damage to the tendons or muscles.
If there is tendon damage, it should be addressed promptly.
If it is not a muscle or tendon injury, then rehabilitation therapy is necessary.

2.
Localized numbness is often caused by injury to the sensory nerves in the epidermis due to surgical procedures, and it usually recovers gradually.

3.
Peroneal nerve injury can occur during surgery for a small bone fracture, which may lead to foot drop, resulting in the inability to lift the ankle and toes.
However, your symptoms seem less indicative of this.
If tendon and muscle issues are ruled out, then further consideration is warranted.

Changhua Hospital cares about your health.

Wang Shou-ji

Reply Date: 2021/07/08

More Info

After sustaining a tibial fracture and undergoing surgery, it's understandable to have concerns about recovery, especially when experiencing issues like the inability to lift your big toe. Let's break down the situation and address your questions.

1. Why Can't I Lift My Big Toe?
The inability to lift your big toe, known as "hallux extension," can be attributed to several factors. Given your history of a tibial fracture and subsequent surgery, it's possible that the injury has affected the nerves or muscles responsible for toe movement. The tibial nerve, which runs down the leg and supplies sensation and motor function to the foot, could have been impacted during the fracture or surgery. Additionally, the muscles that control toe movement may have been weakened or affected by the trauma or immobilization following surgery.

Another potential reason could be related to the healing process. After surgery, especially with complications like infection, there may be swelling or scarring that can impede movement. The fact that you can push down your big toe but not lift it suggests that the muscles may still be functional, but the nerve signals might not be effectively reaching them, or there could be a mechanical restriction.

2. Is It Okay Not to Actively Check This Issue?
While it's true that many post-surgical issues can resolve over time, it's crucial to monitor your recovery closely. The presence of numbness or a tingling sensation in the area extending from your big toe to your ankle could indicate nerve involvement, which should not be overlooked. Delaying further evaluation could lead to complications, especially if there is nerve damage or if the muscles are not regaining strength as expected.

It's essential to communicate your concerns with your healthcare provider. They may recommend imaging studies, such as an MRI or nerve conduction studies, to assess the integrity of the nerves and muscles in your foot. Early intervention can significantly improve outcomes, especially in cases involving nerve function.

Additional Considerations:
- Physical Therapy: Engaging in physical therapy can be beneficial for regaining strength and mobility in your foot. A physical therapist can provide targeted exercises to help improve toe movement and overall foot function.

- Monitoring Progress: Keep track of any changes in sensation or movement. If you notice any deterioration or new symptoms, inform your doctor immediately.

- Infection Concerns: Since you had an infection post-surgery, ensure that you are following up with your healthcare provider to monitor for any signs of complications related to that.

In conclusion, while some recovery issues may resolve on their own, it is vital to stay proactive about your health. Regular follow-ups with your healthcare provider and possibly engaging in physical therapy can help ensure that you regain full function of your toe and foot. Don't hesitate to voice your concerns and seek further evaluation if needed. Your health and recovery are paramount, and addressing these issues early can prevent long-term complications.

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