The EHL tendon passes through its own subcompartment of the inferior extensor retinaculum between the tibialis anterior and EDL compartments. It inserts on the dorsal distal phalanx of the great toe, producing IP joint extension. EHL function — tested by resisted great toe dorsiflexion — is the most sensitive clinical indicator of L5 nerve root function. EHL transfer to the lateral midfoot is used for foot drop reconstruction.
Great toe dorsiflexion; ankle dorsiflexion assistance; the primary indicator of anterior compartment integrity
EHL weakness is an L5 nerve root sign — assessed by resisted great toe IP dorsiflexion. In anterior compartment syndrome, the EHL is the first muscle to become ischemic (most distal). EHL transfer to the cuboid or lateral midfoot replaces the lost tibialis anterior dorsiflexion in tibialis anterior tendon rupture.
EHL tendon division from dorsal foot laceration producing great toe drop managed with primary repair within the retinacular tunnel.
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