600 - Restoring Range: Ultrasound-Guided Hydrodilitation of the First Toe for Post-Surgical Capsular Adhesions

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

CD

Christian Diaz, MD

Resident Physician
University of Miami / Jackson Health System
Miami, Florida, United States

Co-Author(s)

DW

Dylan Wood, MD

Resident Physician
University of Miami
Miami, Florida, United States

Corresponding Author(s)

TT

Timothy Tiu, MD

Associate Professor
University of Miami
Miami, Florida, United States

Co-Author(s)

RM

Reid Mccullough, DO

Resident Physician
University of Miami/Jackson Memorial Hospital
Miami, Florida, United States

Submitter(s)

CD

Christian Diaz, MD

University of Miami / Jackson Health System
Miami, Florida, United States

Case Diagnosis: Decreased first toe metatarsophalangeal (MTP) and interphalangeal (IP) joint range of motion (ROM) secondary to capsular adhesions following traumatic tendon injury and multiple surgical tendon repairs.

Case Description: A 58-year-old woman sustained a crush injury to the first toe after dropping a circular saw, resulting in complete disruption of the extensor hallucis longus (EHL) tendon. She required three surgeries for successful tendon re-attachment. Despite surgical repair and rehabilitation, the patient presented with limited first toe mobility and impaired gait mechanics. Pre-intervention measurements were: first MTP flexion 20°, MTP extension 40°, IP flexion 15°, and IP extension 12°. Ultrasound-guided hydrodilitation of the EHL tendon sheath and IP joint was performed. Following intervention, ROM improved to first MTP flexion 25°, MTP extension 55°, IP flexion 25°, and IP extension 37°, with improved functional tolerance.

Discussions: Surgical repair of tendons is often complicated by adhesion formation and excessive scar tissue, which restrict tendon gliding and joint mobility. Scar tissue develops through fibroblast proliferation and deposition of collagen, which may become disorganized and non-compliant. Adhesions between the repaired tendon, tendon sheath, and joint capsule are recognized as a major source of post-surgical stiffness. Hydrodilitation, traditionally used in adhesive capsulitis and joint contractures, introduces fluid under pressure to mechanically disrupt adhesions and reduce capsular tightness. In this case, hydrodilitation of the EHL tendon sheath and IP joint provided clinically meaningful improvements in both MTP and IP joint mobility beyond conventional rehabilitation.

Conclusions: This case highlights the potential role of ultrasound-guided hydrodilitation in managing chronic stiffness of the first toe after multiple tendon repairs. By addressing adhesions and scar-related restrictions, hydrodilation produced measurable gains in ROM and function. Further studies are warranted to evaluate the efficacy and long-term outcomes of this approach in post-surgical tendon adhesion management.